Wyden probes marketing practices for Medicare Advantage, Part D plans

A key Senate panel is probing whether Medicare Advantage (MA) plans engaged in misleading marketing and aggressive sales tactics, the latest scrutiny of the popular program. 

Senate Finance Committee Chairman Ron Wyden, D-Oregon, sent letters to 15 state insurance regulators Monday asking for information on complaints they have received from 2019 through 2022 on MA and Part D plan marketing. The probe is the latest by the federal government and Congress to explore the MA program, as lawmakers and regulators are also examining prior authorization and risk adjustment practices. 

“I have heard alarming reports that MA and Part D health plans and their contractors are engaging in aggressive sales practices that take advantage of vulnerable seniors and people with disabilities,” Wyden wrote to one of the state regulators. 

He said that a recent survey of state insurance commissioners reported an increase in senior complaints on false and misleading marketing of MA plans. 

Wyden also referenced a 2009 Government Accountability Office report that found the Centers for Medicare & Medicaid Services (CMS) went after at least 73 MA plan sponsors from January 2006 through February 2009 for marketing issues. 

“Given this trend in complaints, I am seeking to better understand the nature and extent of these marketing and enrollment issues,” Wyden wrote. 

He asked state insurance commissioners for a list of all MA and Part D complaints from 2019 through 2022 and examples of false or misleading materials such as mailers or robocalls. 

Wyden also wants to know whether there are certain benefits that are more frequently associated with complaints like dental services or meal benefits. MA plans can offer supplemental benefits that are not available on traditional Medicare such as dental or vision benefits. 

The senator sought to learn the common sources of complaints such as whether they mainly come in response to telemarketers, online outreach or advertising. 

MA has seen explosive growth in popularity in recent years. Enrollment in 2022 grew by nearly 9% compared to the year before. An estimate from the Medicare Payment Advisory Commission (MedPAC) expects most Medicare beneficiaries to be on the program by next year. 

As the popularity of the program has surged, new questions have emerged about its management. MedPAC reported on rampant coding issues where MA plans have used tools such as chart reviews and health risk assessments to add unnecessary diagnosis codes to claims in order to get more money from Medicare. 

An April 2022 report from the Kaiser Family Foundation also found that payments to MA plans as a share of total Medicare spending increased from 26% in 2010 to 45% in 2020. Kaiser expects that figure to increase to 54% by 2030. 

Lawmakers have also raised scrutiny of MA prior authorization practices after a federal watchdog report showed 13% of prior authorization denials among a sample of 250 fit within Medicare coverage requirements. 

MA advocates and insurance lobbying groups counter that MA remains an incredibly popular program among seniors and has a high satisfaction rate.

The advocacy group Better Medicare Alliance said marketing materials are already subject to rigorous regulations and have to be approved by CMS. 

"Policymakers must take action to modernize Medicare enrollment in ways that offer more transparency in coverage choices and empower consumers, rather than criticizing those standing in the gap to help beneficiaries navigate this difficult and complicated process," the alliance's president and CEO, Mary Beth Donahue, said in a statement.