A new report found nearly 10 states reported higher complaints of Medicare Advantage (MA) marketing, including complaints of seniors being misled about a plan’s benefits.
The report (PDF), released Thursday by Senate Finance Committee Chairman Ron Wyden, D-Oregon, calls for the Centers for Medicare & Medicaid Services (CMS) to install new rules such as cutting off cold calls. The report comes as CMS has taken new steps to rein in MA television ads starting next year.
“It is unacceptable for this magnitude of fraudsters and scam artists to be running amok in Medicare and I will be working closely with CMS to ensure this dramatic increase in marketing complaints is addressed,” said Wyden in a statement Thursday.
Wyden called for the report back in August in response to reports of increased complaints to CMS over MA, an increasingly popular program where beneficiaries use their Medicare benefit to acquire a private plan. MA is expected to take up more than half of total Medicare enrollment in 2023.
The report explored materials submitted by 14 states and interviews with other stakeholders. It found nine of the 10 states tracked an increase in complaints to insurance commissioners from 2020 through 2021. CMS reported more than twice the number of complaints for MA marketing over the same time period.
“States reported instances of deceptive marketing material, such as mailers that appeared to be official government documents or advertisements that use ‘Medicare’ in the company’s name or branding,” the report said.
Another concern was marketing plans to beneficiaries that had dementia or were enrolled in a plan without their consent. Sometimes, beneficiaries had their plans inadvertently switched to one that didn’t cover their doctor.
“Some plans experienced substantial disenrollment from their plans due to misleading and aggressive marketing practices by other plans (or their agents and brokers),” the report added.
Wyden’s staff also found that a frequent source of complaints was the plan would offer a bump to seniors’ Social Security checks.
If a plan buys down Medicare Part B premiums, that could result in a higher payment for seniors that choose those plans. However, brokers and agents are apparently employing the additional benefit to lure beneficiaries into plans even if they don't lower the Part B premium.
“Ultimately, this marketing strategy harms beneficiaries more than it helps them,” the report said.
Wyden outlined a series of recommendations CMS should adopt to curb the problem, including reinstating requirements that were loosened by the Trump administration. These include requiring marketing to detail the appeals process and conducting “regular proactive oversight” on a broad range of materials to ensure MA plans aren’t misleading beneficiaries.
CMS should track rapid disenrollment in plans that may be an indicator of misleading marketing practices, he said.
The agency also needs to hold brokers accountable for their actions via regulations and adherence to best practices. Wyden said CMS needs to install tough rules around what can be contained in marketing materials as well as close a loophole that enables cold calling of beneficiaries.
CMS told Fierce Healthcare that it is reviewing the recommendations and “remains committed to the shared goal of protecting people with Medicare from confusing and potentially misleading marketing.”
Late last month, the agency issued new guidance to plans that called for them to get preapproval for MA television spots starting next year. The agency also reminded plans they are responsible for any actions a broker or agent takes on behalf of the plan.
“CMS is closely monitoring marketing activities during the 2023 Medicare open enrollment, including marketing that is misleading, confusing or misrepresents benefit or product,” the agency added.
The MA advocacy group Better Medicare Alliance (BMA) said in a statement that it agrees with the recommendations for CMS to “hold bad actors accountable and we welcome increased direct oversight of third-party marketing organizations, whose activities are currently regulated differently from the marketing conducted by health plans,” said BMA President and CEO Mary Beth Donahue in a statement.