The Kaiser Family Foundation just released a report detailing the many data gaps in Medicare Advantage–the corporate health plan option administered by private health insurers. This missing data is needed to assess Medicare Advantage plan performance and value.
The government requires relatively little data from the Medicare Advantage plans and does not make much of it available for public scrutiny. Moreover, some of the required data is inadequate or incomplete, Yet, the Centers for Medicare and Medicaid Services, which oversees Medicare, rarely holds the Medicare Advantage plans accountable for failing to provide accurate data.
Congress needs to step in to require MA plans to turn over data that people can use to make an informed choice of a Medicare Advantage plan if they’d like. And, it needs to include penalties for Medicare Advantage plan failure to disclose complete and accurate information.
Here are some of the questions for which we have no answers:
- Which plans have the highest rates of denials and which have the lowest?
- Which plans have the highest rates of prior authorizations and for which types of services?
- How quickly do Medicare Advantage plans respond to prior authorization requests?
- Why do Black Medicare Advantage enrollees disenroll from Medicare Advantage plans and why do white enrollees disenroll?
- What share of enrollees use the “extra” Medicare Advantage benefits and what is their income, ethnicity and health status?
The Centers for Medicare and Medicaid Services (CMS) does not have the answers to any of these questions. Without the answers, CMS is forcing people to take big risks when they join a Medicare Advantage plan. How can anyone assume that any particular Medicare Advantage plan offers value or will provide them with the care they need. For example, CMS does not require the Medicare Advantage plans to report the types of services for which there are high levels of prior authorization requests and denials.
The insurers offering Medicare Advantage plans also do not have to distinguish among the plans they offer when they do provide data to CMS. So, if some of their plans have particularly high denial rates and others have low rates, CMS would not know.
Bottom line: There is no way for people to make an informed choice about a Medicare Advantage plan.
Here’s more from Just Care:
- Medicare Advantage: Combating fraud is a challenge because there’s no data on denied claims
- Senators ask Medicare agency why it is not holding Medicare Advantage plans accountable for violating their contractual obligations
- Ten ways to improve Medicare Advantage
- Traditional Medicare v. Medicare Advantage? Different as night and day
- Medicare Advantage plans denied two million prior authorization requests in 2021
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