Medicare Advantage bill introduced by senators to stem complaints

Medicare Advantage bill introduced by senators to stem complaints

The Medicare & You Handbook is mailed to qualified consumers.

Photo: Susan Morse/Health Financing News

U.S. Senators Maggie Hassan (D-NH) and Roger Marshall, MD (R-KS) introduced the bipartisan Medicare & You Handbook Improvement Act, which aims to ensure that when seniors weigh their Medicare coverage options, they have necessary information. need on the choice of health plan and complementary insurance.

The bill was developed in part in response to growing complaints from seniors about aggressive marketing practices for Medicare Advantage plans.

The Centers for Medicare and Medicaid Services acknowledged those complaints in October, saying some of Medicare Advantage’s recent advertisements and marketing materials were “confusing, misleading, or inaccurate,” at least in the minds of consumers.

Kathryn A. Coleman, director of the agency’s Medicare Drug and Health Plan contract administration group, recently sent a letter to all Medicare Advantage Organizations (MAOs) and drug plan sponsors stating that CMS will improve its review of MA-related marketing materials. These documents must be submitted under the “File and Use” regulatory authority for the MA and Part D drug plans.

She reminded Medicare Advantage Organizations (MAOs) and Part D sponsors that they are responsible for the marketing activities of agents, brokers, and other third-party entities with whom they contract.

Hassan and Marshall’s bill aims to improve educational materials for seniors during the annual Medicare open enrollment period and addresses concerns seniors have shared about inadvertently selecting unresponsive Medicare plans. best meet their health care needs.

“When deciding whether to enroll in traditional Medicare or a Medicare Advantage plan, seniors rely on the official Medicare & You handbook,” Hassan said. “Unfortunately, the handbook does not fully address the challenges that Medicare Advantage may create for older adults. My bipartisan bill would remedy this by improving the handbook and adding key information that is currently missing.”

Marshall said he has become “increasingly concerned” about mass marketing ad campaigns during open registrations.

“The Medicare & You handbook has improved over the years, but still falls short of sharing some vital information about health plan choices and supplemental health insurance,” he said.


The Medicare & You Handbook is the official handbook that guides new and current Medicare beneficiaries about the Medicare program. Published by CMS, the handbook is sent to every Medicare home each fall and includes a summary of Medicare benefits, patient protections, a list of available health and drug plans, and some Medicare FAQs.
In particular, it provides a comparison between Original Medicare and Medicare Advantage. Although the manual has evolved over the years to be more user-friendly, it lacks information on techniques that help MA plans control costs, the senators said.

The bill would require CMS to include a description of what use management techniques are, including prior authorization and step therapy, and how a recipient can find out which techniques apply in connection with the use. an MA plan or a specific drug plan.

It would also instruct CMS to include a description of the size of the MA plan network relative to the number of health care providers accepting Original Medicare; and an explanation that when seniors switch to an MA plan and later switch back to Original Medicare, they may be prohibited from purchasing additional coverage or they may have to pay much higher premiums.

The bill is intended to complement the Improving Timely Access to Care for Seniors Act, legislation that aims to modernize Medicare Advantage and make health care delivery more patient- and physician-friendly. This bill – sponsored by Marshall and co-sponsored by Hassan – has the support of 50 senators and more than 500 national and state organizations.

Hassan also joined his colleagues in calling on the Biden administration to implement additional consumer protections in Medicare Advantage following an increase in reports of deceptive marketing practices targeting seniors in the program, and joins the New Hampshire congressional delegation in urging CMS to take action to protect eligible individuals. New Hampshire Medicare beneficiaries subjected to aggressive and potentially predatory marketing tactics related to the sale of Medicare Advantage plans or other insurance products.


CMS reviewed thousands of complaints and hundreds of audio calls, and said it identified numerous issues with TV and newspaper ads, mailings and internet searches. The agency called the numbers associated with these ads as part of a “secret shopping” campaign to monitor these ads.

“Our Secret Procurement activities found that some agents failed to comply with applicable regulations and exerted undue pressure on recipients, and did not provide accurate or sufficient information to help a recipient make a decision to lit registration,” Coleman wrote in October.

CMS has outlined a number of recommended best practices for MAOs and Part D sponsors, including ensuring grantees know how to file a marketing complaint with 1-800-MEDICARE or the plan and informing recipients that it is important to provide an agent or broker name, if possible.

He also suggested that sponsors ensure that all plan agents and marketing materials clearly state when certain benefits may not be available to all enrollees.

Twitter: @JELagasse
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