CMS Asks: Are People Being Steered Away from Their Best Insurance Options?

The Medicare Rights Center (Medicare Rights) responded to a request for information (RFI) from the Centers for Medicare & Medicaid Services (CMS) asking about inappropriate steering practices encouraging people into coverage that is not right for them. CMS raises concerns about whether providers, plans, or others who stand to gain from an individual’s enrollment decisions may improperly influence people who may be eligible for Medicare or Medicaid to decline public health insurance and retain private market coverage or convince people to give up private market coverage in favor of Medicare or Medicaid. CMS also asks whether third party payments for premiums might constitute improper steering.

While Medicare Rights agrees with CMS that people should make enrollment decisions independently, without inappropriate influence, our comments also point out that many people lack accurate, unbiased information to help them make good enrollment choices. Comprehensive information from neutral sources, like the State Health Insurance Assistance Programs (SHIPs) and CMS, can protect people from misleading information or steering behaviors.

The decision to enroll in Medicare when first eligible is not simple, and depends on many factors, including whether the person is eligible for Medicare based on their age, if they are receiving SSDI, or because they have End Stage Renal Disease (ESRD). Individual must also weigh their work history, income level, whether they are eligible for tax credits, and the other types of insurance they have access to.

Because the rules are complicated and there is not one choice that is right for everyone, Medicare Rights’ comments urge CMS to focus on specific behaviors of entities that might steer people, rather than the outcome or final decision of beneficiaries. For example, with regard to third-party payments, the comments urge CMS to develop clear rules to establish what types of payments systems are appropriate, like those that allow people to choose whether the payment goes to private insurance or Medicare premiums.

Read the comments: