Senators call for more Medicare Advantage consumer protections


Photo: Manuel Breva Colmeiro/Getty Images

Eleven Democratic senators sent a letter to the Centers for Medicare and Medicaid Services, calling on the federal government to enact stronger consumer protections for Medicare Advantage in light of their concerns about the program’s marketing practices.

This concern was spurred, in part, by a recent report released by Senate Finance Committee Chairman Ron Wyden, D-Ore., alleging that MA’s misleading advertising can sometimes obscure the true benefits of a plan.

Majority staff of the Senate Finance Committee launched an investigation in August, gathered information on marketing complaints from 14 states and found evidence that recipients are inundated with aggressive marketing tactics as well as false information and misleading.

As a result of these practices, the senators said, “elderly people, people with limited financial resources, and people with disabilities were subject to higher fees, difficulty accessing care, and delayed care due to the uncertainty of their coverage.”

While the number of complaints about MA’s misleading marketing is growing, the concerns themselves are not new, the senators said. Congress has addressed marketing abuses in the MA program as early as 2008, with CMS issuing civil monetary penalties to MA plans related to their marketing tactics. One such case led CMS to open a special enrollment period for beneficiaries to research new plans.

Democratic senators accuse the Trump administration of weakening basic consumer protections that Congress had enacted and loosening oversight of CMS. They urged the current administration to take a number of steps.


CMS should reinstate consumer protections in place before the Trump administration, such as banning educational and marketing events from occurring on the same day at the same location, and requiring marketing materials to outline the complaints and disputes process. call, says the letter.

The CMS should also track rapid unsubscribes and those who benefit from special marketing registration periods issued by MA plans as well as brokers and agents; requiring agents and brokers responsible under agency regulations for PA plans to review a beneficiary’s prescription drugs and regularly visit health care providers to ensure that a new plan or renewal plan meets the needs of a beneficiary; and prohibit MA plans from contracting with entities that design materials to suggest they are from the Medicare program or another federal agency.

They also urged the federal agency to support what they see as unbiased sources of information for beneficiaries, including state health insurance assistance programs and the Senior Medicare Patrol.


The letter acknowledged that CMS had taken some steps to curb potentially troublesome MA marketing. 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 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.

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 shopping activities have discovered that some agents are not complying with applicable regulations and exerting undue pressure on beneficiaries, as well as failing to provide accurate or sufficient information to help a beneficiary make a decision to ‘enlightened inscription,’ Coleman wrote.

She reminded AAMs and Part D sponsors that they are responsible for the marketing activities of agents, brokers and other third-party entities with whom they contract.

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.

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