What do you think of Medicare Advantage?

By Kiplinger Consumer News Service
Posted on March 19, 2024

The Centers for Medicare & Medicaid Services (CMS) is asking for your help as it seeks to increase the transparency of the privately managed Medicare Advantage (MA) plans and to strengthen the program’s data capabilities.

While traditional Medicare — Parts A and B — covers a large portion of medical expenses after you turn 65, there are things Medicare doesn’t cover [Ed. note: such as vision, hearing and dental expenses]. This is where Medicare Advantage, a supplemental plan, can help.

But consumers do not always have access to all the information they might need before they make a choice among MA plans.

“Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their healthcare is a black box,” Xavier Becerra, secretary of the Department of Health and Human Services, said in a statement.

“The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions. It deprives researchers and doctors of critical data to evaluate problems and trends in patient care.”

To that end, the CMS has issued a request for information (RFI) for the public at large to give data-related input on all aspects of the Medicare Advantage program. The CMS said the information it gathers from the RFI will help it measure what is and is not working and be used to guide policymaking.

Comments are due by May 29.

Need for data is paramount

“In healthcare, you can’t improve what you don’t know, and the way to know is with data,” said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare.

The types of information requested includes data on access to care, prior authorization, provider directories and networks; supplemental benefits; marketing; care quality and outcomes; value-based care arrangements and equity; and healthy competition in the market, including the effects of vertical integration and how that affects payment.

Transparency is especially important, the CMS said, because Medicare Advantage enrollment has grown to more than 50% of Medicare enrollment. This puts the government on the hook for about $7 trillion in payments to Medicare Advantage health insurance companies during the next decade, it said.

The CMS said that the information solicited by the RFI will support its efforts to:

Ensure MA plans best meet the needs of people with Medicare.
Ensure that people with Medicare have timely access to care.
Ensure that MA plans appropriately use taxpayer funding.
Ensure that the MA market has healthy competition.

To access the RFI, visit the Federal Register’s webpage at bit.ly/MAcomments and click on “Submit a formal comment.” You may submit comments via the website, or mail them to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-4207-NC, P.O. Box 8013, Baltimore, MD 21244-8013.