MA Limitations, Favoritism, and Quality & Access Issues – New York Times

A recent article in the New York Times highlights a number of concerns about the Medicare Advantage (MA) program, many of which have been raised by the Center for Medicare Advocacy.  The concerns include the growing imbalance between MA and traditional Medicare, the limitations on consumer choice and ability to purchase Medigap plans, and efforts by the Centers for Medicare & Medicaid Services (CMS) to steer people towards enrollment in MA plans. “Medicare’s Private Option Is Gaining Popularity, and Critics” by Mark Miller, appeared in the Times online on Feb. 21, 2020, and in print on February 22.

Miller highlights limitations on consumer choice of coverage: “one of the least understood implications of selecting Advantage when you enroll in Medicare: The decision is effectively irrevocable.” Highlighting the difficulty of obtaining a Medigap plan in most states after a 6 month period when first signing up for Part B, the article notes that “After that time, you can be rejected or charged more, unless you live in one of four states […] that provide some level of guarantee to enroll at a later time with pre-existing condition protection.”

The article points out the growing imbalance between MA and traditional Medicare due to changes in law and policy, an issue the Center has repeatedly raised: “[t]he rise of Advantage has also been aided by changes in federal law and regulation in recent years. And under the Trump administration, critics say, Medicare’s administrators have been tipping the scales improperly in favor of Advantage.” This has occurred, in part, because “[l]egislation and regulatory changes in recent years have favored Advantage by permitting new supplemental benefits and more favorable enrollment rules.”

Miller notes that the privatization of Medicare has escaped scrutiny among policymakers, including those who are discussing using Medicare as a vehicle or model to expand health coverage:

The growth has occurred without much public policy debate about the effects of large-scale privatization on patient health, and on the costs to both the government and enrollees. As “Medicare for all” is debated in the 2020 presidential race, most voters perceive that these proposals are calling for a government alternative to commercial health insurance — yet the current Medicare program is shifting toward greater privatization, not less.

“When we talk about Medicare for all or public options,” said Tricia Neuman, director of the Medicare policy program at the Kaiser Family Foundation, “people may not realize that we already have a Medicare program that is coming to be dominated by some very large private insurance companies.”

The article also discusses how the federal agency administering the Medicare program is steering people towards MA enrollment rather than providing unbiased, objective information about coverage options. Stakeholders, including the Center for Medicare Advocacy, cited in the article, contend that CMS “has become a cheerleader for Advantage plans at the expense of original Medicare” and that there is “bias in educational and outreach materials on enrollment, and in public statements” by the agency. Miller notes that “communications from [CMS] during last fall’s Medicare enrollment period do appear to promote Advantage plans” as discussed in previous Alerts by the Center for Medicare Advocacy, including here and here.

Finally, the article highlights MA quality and access issues: “[t]he evidence is mixed” with respect to whether MA or traditional Medicare “produces better health outcomes.” Miller cites, among other things, a 2018 Office of Inspector General (OIG) report finding “‘widespread and persistent problems related to denials of care and payment in Medicare Advantage’ plans” as discussed in a previous Center Alert. Focusing on the plight of a Medicare beneficiary profiled for the article, Miller notes that “[s]erious illness is a common motive for leaving an Advantage plan, according to many Medicare advocates and counseling services.”