Ahead of the Centers for Medicare and Medicaid Services’ (CMS’) release of proposed payment policy for Medicare Advantage plans, Senator Elizabeth Warren and Representative Pramila Jayapal sent a letter to the Centers for Medicare and Medicaid Services detailing ways the administration could wipe out a projected $100 billion in overpayments to MA plans this year alone. Among other things, the letter proposes ending contracts with MA plans that violate their duty to cover Medicare benefits.
“It is imperative for [Medicare] to rein in these abuses and protect Medicare coverage for the seniors and people with disabilities who rely on it,” say Warren and Jayapal. Last month, Senator Warren wrote CMS to start collecting critical data needed to oversee the Medicare Advantage plans.
Thirty-one million older adults and people with disabilities are enrolled in Medicare Advantage plans. These health plans cost taxpayers $500 billion last year. But, substantial evidence indicates that the government overpays insurers offering these plans tens of billions of dollars each year; and, some, if not many, of these MA plans inappropriately deny and delay care to their enrollees, especially care for people with complex and costly conditions.
The Biden administration has taken some steps to end some of the overpayment abuses. But, many experts believe there’s a lot more to be done. Mark Miller, former director of the Medicare Payment Advisory Commission, says “If [the Centers for Medicare and Medicaid Services] backs down … then the beneficiary and taxpayer lose.”
CMS gave the insurers immunity from overpayments detected over seven years of audits. CMS now plans to conduct more auditing of MA plans’ billing processes. Warren and Jayapal are looking for payment policy changes as well as audits. For example, they want the government to adjust payments to MA plans because their enrollees are healthier than enrollees in Traditional Medicare.
The five-star quality rating system for MA plans also needs an overhaul. People cannot rely on the star-rating system as an indicator of whether an MA plan inappropriately denies care or has a narrow network that undermines their ability to get good care. Yet, the government pays insurers more for MA plans with a 4 or 5 star-rating.
Moreover, some data show that some MA plans provide their enrollees fewer benefits than they would get in Traditional Medicare, even though they are legally required to cover the same benefits. CMS has not penalized plans that inappropriately deny care. Warren and Jayapal want CMS to hold them accountable and end their contracts.
In some instances, UnitedHealth Group has denied rehab care to patients in critical need of rehab, based on computer algorithms, to the detriment of their enrollees’ health and well-being. Even though CMS said it may punish insurers who violate their contracts by wrongly denying care, it has yet to do so.
CMS has ended contracts with Centene Medicare Advantage plans in Arizona and North Carolina because their star-ratings were three or below for three years running.
Here’s more from Just Care:
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Even with billions in overpayments, Medicare Advantage insurers are losing value
- Don’t assume a five-star Medicare Advantage plan will provide the care you need
- New study finds you can’t meaningfully choose among Medicare Advantage plans
- Ten ways to improve Medicare Advantage
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