Would standardizing Medicare Advantage plans protect people from making a bad choice?

The Medicare Payment Advisory Commission, “MedPAC,” in its June 2023 report to Congress, makes the compelling case that the government should standardize Medicare Advantage plans. The MedPAC report underscores how difficult it is for people to choose among these health plans offered by corporate health insurers. But, standardization alone will not allow people to make a meaningful choice or to protect themselves against corporate health insurers that are bad actors.

MedPAC does not explain that the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicare, either does not have, or withholds, information about Medicare Advantage plans that people need in order to make an informed choice. MedPAC does not make the case that more information must be provided to people choosing a Medicare option. Without additional information on plan delay and denial rates, for example, it’s hard to imagine that people could make a meaningful choice.

People enrolling in a Medicare Advantage plan today take a risk that they will end up in a plan that inappropriately delays and denies them the care they need, potentially endangering their health and well-being. According to the HHS Office of the Inspector General (OIG), some Medicare Advantage plans engage in widespread and persistent inappropriate delays and denials of care and coverage but CMS does not name these plans. Rather CMS’ star-rating system misleads people into believing that they will get the care they need in a Medicare Advantage plan with a four or five-star rating, even though those plans might be engaged in widespread inappropriate delays and denials of care.

Right now, it is impossible for people to compare their Medicare Advantage options; they have 41 of them on average. Even the smartest people out there and the people most knowledgeable about Medicare Advantage can’t compare these plans in a meaningful way. People with cognitive impairments, low health literacy levels, or who speak English as a second language are at a total loss.

Medicare Compare is the government tool designed to help people choose among Medicare Advantage plans. But, Medicare Compare doesn’t let you know which plans have the highest denial and delay rates, the highest mortality rates, the poorest provider networks and other telling quality measures. The most you know is whether a plan has a four or-five star rating, and the government gives out high ratings regardless of delay and denial and mortality rates.

CMS needs to standardize benefits in Medicare Advantage plans and limit the choices available to people. Too much choice is confusing and unhelpful. CMS also needs to disclose in an easily accessible form information about the plans that are violating their contractual obligations and putting their enrollees’ health at risk, which CMS has so far failed to do.

With the plans in the State Health Exchanges, CMS  offers four options, bronze, silver, gold and platinum. For each metal type, it standardizes the plan’s deductible, out-of-pocket limit, and cost sharing amount for most major service categories, including prescription drugs.

Here’s more from Just Care:

• The choice between traditional Medicare and Medicare Advantage: It’s a sham
• Medicare ratings of Medicare Advantage plans a farce
• OIG finds widespread inappropriate care denials in Medicare Advantage
• Does your Medicare Advantage plan deny care frequently? Who knows
• How to get free or low-cost dental care