Advocacy groups blast CMS for incorrectly promoting MA plans, misleading beneficiaries

Medicare enrollment form and pen
Three health advocacy groups are calling out the CMS for improperly "mischaracterizing" Medicare Advantage plan benefits in educational documents. (Getty/zimmytws)

Three Medicare beneficiary groups say the Centers for Medicare & Medicaid Services (CMS) is improperly propping up Medicare Advantage plans by misinforming beneficiaries through official educational documents. 

The Medicare Rights Center, the Center for Medicare Advocacy and Justice in Aging said in a letter (PDF) to CMS that the draft 2019 handbook "distorts" and "mischaracterizes" what is covered under Medicare Advantage plans, possibly favoring them over traditional Medicare.

The letter states the draft material doesn't inform beneficiaries of the limited choices for providers under MA plans and improperly states that prior authorization, which is required for MA plans, is a "benefit" instead of a restriction for patients.

Conference

13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

The groups added that the material implies that MA plans are a less expensive option for seniors. 

The handbook is an official government publication that provides Medicare beneficiaries with information about the program, including their options for coverage. 

RELATED: CMS to release Medicare Advantage encounter data as part of new data-driven strategy

"CMS has a duty to provide complete, unbiased information to help beneficiaries make the best choice for their Medicare coverage," Judith Stein, executive director of the Centers for Medicare Advocacy, said in a statement. "Regrettably, the current version of Medicare & You does not fully and fairly inform people of the pros and cons of Original Medicare vs. Medicare Advantage."

The letter comes at a time when the Trump administration is pushing for enrollment in MA plans as a way of reducing federal spending. 

The agency recently released for the first time MA encounter data in an effort to further research the program's efficiency and rapid growth. The plans have also provided a financial boost for private insurers. 

Suggested Articles

Humana is teaming up with telehealth company Doctor on Demand to launch a new virtual care model focused on primary care.

A federal judge in Pennsylvania has tossed UPMC’s class action suit against the state’s attorney general.

Seema Verma said Thursday that while the Trump administration has focused on voluntary payment models to date, that is likely to change.