October 30,2024

Democratic Health Leaders Warn Medicare Advantage is Falling Short for Seniors, Americans with Disabilities

Finance, Ways and Means, Energy and Commerce Democrats Raise Concerns About Growing Usage of Prior Authorization, Ghost Networks and Aggressive Marketing Among Medicare Advantage Plans

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., House Ways and Means Committee Ranking Member Richard E. Neal, D-Mass., and House Energy and Commerce Committee Ranking Member Frank Pallone Jr., D-N.J., today warned that Medicare Advantage (MA), an optional, private insurance alternative to traditional Medicare, is failing to live up to the standards Americans expect of the Medicare program.

“In many instances Medicare Advantage plans are failing to deliver, compromising timely access to care and undermining the ability of seniors and Americans with disabilities to purchase the coverage that’s right for them,” the members wrote. “We call on CMS to use every regulatory, oversight, and enforcement tool at the agency’s disposal to rein in rampant misuse of prior authorization, simplify the experience of choosing a Medicare plan, and put an end to rampant marketing abuses.”

“The Medicare program has taken positive steps in recent years to improve consumer protections, but much more needs to be done in order to hold Medicare Advantage plans accountable for inappropriate delays and denials of care and marketing misconduct” said David Lipschutz, Co-Director of the Center for Medicare Advocacy. “We applaud Chairman Wyden of the Senate Finance Committee and Ranking Members Neal of Ways & Means and Pallone of Energy & Commerce for calling for more oversight and transparency regarding the Medicare Advantage industry.”

“Medicare beneficiaries deserve coverage that puts their health care needs above insurers’ bottom lines, but time and time again we see proof that Medicare Advantage plans play games to delay and deny patient care. FAH thanks Chairman Wyden, along with Ranking Members Neal and Pallone, for their leadership protecting patient access to care and we urge CMS to hold MA plans accountable,” said FAH Executive Vice President of Public Affairs Charlene MacDonald.

“The American College of Surgeons remains committed to improving care for surgical patients. The overutilization of prior authorization in Medicare Advantage plans has rapidly increased over the last several years,” said American College of Surgeons Executive Director and CEO Patricia L. Turner, MD, MBA, FACS. “We thank Congressional leaders for strongly supporting increased transparency and streamlining this overly burdensome process to ensure patients have access to timely and high-quality care as part of its oversight of Medicare Advantage plans' use of prior authorization.”

Medicare Advantage was created to provide seniors and people with disabilities with private-sector plan options that could offer care coordination and extra benefits. The letter raises concerns about several ways MA plans are failing to deliver for seniors and Americans with disabilities, including the growing use of prior authorization to deny or delay care and in particular the use of algorithms and artificial intelligence tools to make coverage determinations. The letter also highlights shortfalls among MA plans when it comes to core Medicare medical benefits or access to providers, as MA plans focus marketing efforts on supplemental benefits like gym memberships and flex cards. 

The full letter can be found here.

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