Published: Nov. 29,
2019 at 9:34 a.m. ET By Max Richtman
Seniors need better information on their options to make
important health care choices
Medicare open enrollment season is supposed to
be a time when enrollees can choose the best coverage based on accurate,
unbiased information from the federal government. Unfortunately, the Trump
administration’s enrollment tools show a continuing bias toward private
Medicare Advantage (MA) plans over traditional Medicare.
This is not surprising. The Centers for
Medicare and Medicaid Services (CMS), under its current leadership, seems to
behave as if its main priority is to privatize the Medicare program.
Making Medicare coverage decisions is a
complex task with multiple personal considerations. Beneficiaries need help
understanding their options — including the pros and cons of traditional
Medicare and private Medicare Advantage. They need to make fully informed
choices given their existing and projected health needs, financial
circumstances, and potential assistance with cost-sharing. In a 2018 poll of
our organization’s members, more than half of respondents said they make
enrollment decisions through online research.
Traditionally, Medicare enrollment materials
have been neutral regarding the two basic types of coverage. But starting in
2018, advocates noticed that the public outreach (including its Medicare and You handbook) seemed to steer
enrollees toward Medicare Advantage by overemphasizing the positives of private
plans while downplaying the negatives, and limiting — or outright omitting —
references to traditional Medicare. As David Lipschutz of the Center for Medicare Advocacy noted, the handbook
characterized Medicare Advantage as “less expensive by default” and listed
“prior authorizations” for certain types of care as a “benefit,” rather than an
impediment, for patients.
Under pressure from advocates, the Centers for
Medicare and Medicaid Services revised the handbook to mitigate some — but not
all — of these biases. Fast-forward to the 2020 open enrollment season: the
handbook is somewhat improved, but CMS’s online enrollment tools remain slanted
toward MA plans.
When enrollees visit the Find a Plan feature at Medicare.gov, they can
click a button to explore coverage options. The next screen asks, “What type of
2020 coverage are you looking for?” The first choice is “Medicare Advantage
Plan,” followed by Part D prescription drug plans and Medigap supplemental
insurance. The list of options does not even include traditional Medicare,
which covers 66% of all beneficiaries. A new enrollee could be forgiven for not
knowing that the original program signed into law in 1965 still exists.
Only by clicking “Learn more before seeing
plans” and entering a zip code do visitors see an option for traditional
Medicare, which CMS refers to as “Original Medicare.” Neutral language informs
enrollees that the traditional plan includes Part A hospital insurance and Part
B medical, but that beneficiaries must purchase drug and supplemental insurance
separately.
Below that is a blurb touting Medicare
Advantage as an “all-in-one alternative to Original Medicare” that offer “extra
benefits — like vision, hearing, dental and more,” which sounds more like
advertising than straightforward information. In fact, during the 2019 open
enrollment season, CMS sent emails to millions of older Americans
encouraging them to choose Medicare Advantage. “Get more benefits for your
money,” said one message. “See if you can save money with Medicare Advantage,”
implored another.
(Editor’s note: The Centers for Medicare and
Medicaid Services did not immediately respond to a request for comment on
whether its tools favor Medicare Advantage.)
It’s fair to ask: Why does it matter if
official enrollment information favors Medicare Advantage? While MA may be a
reasonable choice for some younger, healthier seniors, it has some built-in
disadvantages compared with traditional Medicare. Medicare Advantage offers a
limited network of health care providers. Provider networks can change from
year to year with little or no warning. Patients may not be able to see their
preferred doctors or specialists. Specialist visits may require troublesome
pre-authorizations.
Unlike traditional Medicare beneficiaries, MA
enrollees cannot purchase supplemental Medigap coverage to help with copays and
deductibles, which sometimes can be costly — and often unaffordable. If
patients develop chronic or serious health issues as they age, and wish to
switch to traditional Medicare, they may not be able to obtain Medigap insurance
to help cover out-of-pocket costs, because those policies are not guaranteed to
be issued six months after a beneficiary first enrolls in Medicare.
Medicare Advantage was created with the belief
that the private insurance market could deliver seniors’ health care more
efficiently than the traditional program. But MA plans have proven to be less
cost effective than traditional Medicare. In addition, Medicare Advantage
insurers have been caught overcharging the federal government to the tune of $10 billion a
year. Meanwhile, HHS audits have raised concerns that Medicare
Advantage patients have been denied appropriate services, potentially causing
“physical or financial harm” and representing a “misuse” of federal Medicare
dollars. Taxpayers pick up the bill, while the Trump administration continues
to push Medicare Advantage on new enrollees.
We and other senior-advocacy groups have
called upon the administration to level the playing field between traditional
Medicare and MA plans. Instead, the president issued an executive order in
October effectively doubling-down on that bias. The executive order requires
federal agencies to examine regulations and practices to make sure that
traditional “Medicare is not advantaged or promoted over [Medicare Advantage]
with respect to its administration.” In other words, the executive order aims
to solve the exact opposite problem of the one that really exists. It will
intensify — rather than mitigate — the bias toward private plans and against
traditional Medicare.
Alarmed by the administration’s lack of
objectivity, our organization joined forces with the Center for Medicare
Advocacy to provide the public with objective, accurate information about enrollees’
options. Unlike the administration, our goal is not to steer enrollees toward
one program or the other, but to make sure they are positioned to make the best
possible choices. Advocates will continue to press the Trump administration to
level the playing field, but we may have to wait for a new president to
prioritize public good over private profit in the Medicare program.
Max Richtman is president and
CEO of the nonprofit National
Committee to Preserve Social Security and Medicare, promoting the financial
security, health and well-being of older Americans. He is former staff director
of the U.S. Senate Special Committee on Aging.
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