Senate Dems press CMS for more consumer protections in Medicare Advantage

A group of Senate Democrats is calling for more consumer protections in Medicare Advantage (MA) to be put in place “as soon as possible.”

Eleven Democrats wrote Tuesday to administration health officials (PDF) concerned over marketing practices in the popular program, which is in the middle of open enrollment through Dec. 15. 

“False and misleading marketing and fraudulent sales practices create confusion and can undermine continuity of care,” according to the letter led by Sen. Ron Wyden, D-Oregon, chairman of the Senate Finance Committee. 

Wyden recently released a report that found complaints about marketing had increased in nine states from 2020 through 2021.

“The investigation showed how unscrupulous marketing practices lured beneficiaries to enroll in MA plans—sometimes without their explicit consent—only to find out that the agent misrepresented the plan’s benefits or available providers,” according to the letter to the leaders of the Department of Health and Human Services as well as the Centers for Medicare & Medicaid Services (CMS).

Wyden’s report released a series of recommendations for CMS, which are echoed in the letter pushing for reform.

“CMS should reinstate consumer protections in place prior to the Trump administration, such as prohibiting educational and marketing events from occurring on the same day at the same location, and require marketing materials to describe the grievance and appeals process,” the letter said.

It called for CMS to create new guidelines and training for agents and brokers. The Democrats press CMS to also close a loophole that enables MA plans to conduct cold-calling of seniors. 

The agency should prohibit agents and brokers from purchasing any leads and stop them from calling a senior several times a day for “days in a row,” the letter said. 

CMS said in a statement to Fierce Healthcare that MA marketing is a very important issue and it is reviewing the letter's recommendations.

"CMS remains committed to the shared goal of protecting people with Medicare from confusing and potentially misleading marketing while also ensuring they have the accurate and necessary information to make the coverage chocies taht best fit their needs," the agency said. 

In late October, CMS released new guidance to MA plans that starting next year all television ads will need to get preapproval before going on air. The agency also reminded plans they are responsible for the actions of any brokers or agents. 

The latest MA and Part D rate notice final rule published back in May also boosted oversight of third-party marketing organizations to root out any misleading or confusing practices. 

The group Better Medicare Alliance, which advocates for MA support in Congress, said it agrees there needs to be greater CMS oversight of third-party marketers. The group has been in talks with members of the committee and is fully supportive of its “recommendation that CMS use its enforcement authority to hold bad actors accountable,” said President and CEO Mary Beth Donahue.

The Senate Finance Committee appears likely to continue to investigate the MA market now that Democrats are assured a slim majority after the midterm elections.

However, widespread legislative action appears doubtful as Republicans are poised to take over the House and MA has broad bipartisan appeal. A January 2022 letter from 346 House members (making up 80% of the total chamber) voiced support for MA.

Wyden’s letter comes as the MA program is becoming more and more popular and is expected to make up more than half of total enrollment in Medicare in 2023.