Medicare Rights Urges CMS to Focus Beneficiary Needs on Parts MA and D
This week, Medicare Rights submitted comments in response to the Centers for Medicare and Medicaid Services (CMS)’s annual Medicare Advantage (MA) and 2027 Part D proposed rules. The proposed rule has some positive ideas but reverses course in several important areas. If finalized, these changes would allow for more aggressive and misleading marketing while eliminating requirements for plans, agents, and brokers to share important information with beneficiaries and the public.
positive side
Better public access to risk-adjusted data
One of the highlights of the proposed rule would help provide public access to risk-adjustment data, one of the factors that affects how plans are paid. We support this proposal because it would improve research and oversight and help combat overpayment.
Assist MA participants when provider withdraws from plan
Another potential policy is to streamline the process for beneficiaries to enter a Special Enrollment Period (SEP) when their healthcare provider no longer participates in the plan's network. We support the changes outlined because it will help people change plans to continue seeing the provider of their choice, promoting continuity of care and beneficiary choice.
We support a potential policy that would streamline beneficiary access to standard essential patents when their providers no longer participate in a plan network.
Allow comprehensive D-SNP participants to retain their coverage
The proposed rule would relax upcoming requirements that would force dual-eligible special needs plan (D-SNP) enrollees in some states, including New York, to drop more plans that integrate Medicare and Medicaid coverage. We support this proposal, but we continue to urge CMS to help states and plans truly consolidate coverage for dually eligible individuals.
Another proposal would change the rules regarding when certain D-SNP participants can be automatically enrolled in other plans. While enrollees are able to reverse such changes, these types of passive enrollment often result in people being unable to access their provider of choice or being very confused about their coverage. We oppose this proposal and others that interfere with beneficiaries' ability to actively choose their own coverage. Beneficiaries should not be forced to participate in a plan that they did not freely choose.
negative factors
The fall back on marketing restrictions
Unfortunately, much of the rule will undermine beneficiary safeguards by allowing marketers to blur the distinction between educational campaigns and sales pitches, allowing call centers to collect private data from beneficiaries without telling them what plans they are selling, and eliminating buffers that currently allow potential participants to seek feedback or other assistance from friends and family.
Another proposal we strongly oppose would allow marketers to stop directing callers to SHIP, which provides objective, free, one-on-one assistance.
Another proposal we strongly oppose would allow marketers to stop directing callers to the State Health Insurance Assistance Program (SHIP), which provides objective, free, one-on-one assistance to Medicare beneficiaries, their families and caregivers. This will increase reliance on biased information sources such as agents and brokers and create unnecessary hardship for beneficiaries.
We urge CMS to withdraw these proposed changes. Instead, more should be done to ensure that program marketing is limited, direct, clear and honest.
Deny important information to registrants
Other aspects of the rule would further limit the information plans must share with beneficiaries. One proposal would eliminate the requirement that plans notify participants of unused supplemental benefits and how to access them. We support the creation of this notice because although many people choose MAs to receive supplemental benefits, they often go unused, suggesting that access or other barriers exist. Helping people track their benefits can improve utilization and identify needed reforms.
Other proposals would eliminate the requirement for plans to evaluate and publicly publish whether they treat all participants fairly in their prior authorization policies and procedures.
Other proposals would eliminate the requirement for plans to evaluate and publicly publish whether they treat all participants fairly in their prior authorization policies and procedures, and exempt them from the requirement that they notify participants that they can receive help and information in other languages.
We strongly oppose these efforts to limit not only the information plans must provide to participants or potential participants but also to limit public liability for poor plan conduct.
Documented health insurance rights
In our comments, Medicare rights groups opposed these negative proposals and supported those that would help Medicare patients get the care they need. We will continue to urge CMS to rescind or modify provisions that prioritize insurance companies over seniors and people with disabilities and eliminate provisions that provide accurate and unbiased sources of assistance. In a time of affordability challenges and health system upheaval, Medicare must be a safe, stable bastion of high-quality care.
Read the proposed rule.
Please read our comments on the proposed rule.
