New Campaign Urges Commonsense Medicare Advantage Reforms

The Action Network Initiative (ANI), a non-partisan advocacy network that supports the mission of Arnold Ventures (AV) to maximize opportunity and minimize injustice through evidence-based policy reform, recently launched a campaign highlighting needed Medicare Advantage (MA) modernizations.

This effort comes on the heels of CMS’s proposed 2024 MA payment updates. In draft rules earlier this year (known as the Advance Notice), CMS recommended small but important changes to how MA payments are calculated. Overall, these policies would increase plan payments by 1%—about $4 billion—in 2024. This is a lower growth rate than in recent years, a key step towards correcting MA overpayments.

MA payment inaccuracy is a recognized and actionable problem. AV explains, “[t]he evidence is clear that Medicare Advantage plans are overpaid. Abusive and in some cases fraudulent billing practices by insurance companies have been well documented. Reforms are urgently needed to improve program integrity and hold Medicare Advantage plans accountable for providing value to beneficiaries and taxpayers.” Several AN provisions would help advance these goals. AV notes the adjustments “would begin to crack down on the fraud and waste by insurance companies and reduce improper and inflated payments to insurers,” and that additional solutions could more fully “hold insurance companies accountable.”

A new national survey shows current and future Medicare beneficiaries agree—they overwhelmingly support addressing MA payment flaws, including as outlined in the 2024 AN:

• 90% favor reforms to reduce MA overpayments.
• 70% want policymakers to prevent fraudulent MA plan billing practices.
• 65% say MA plans should be held accountable for providing value to beneficiaries and taxpayers.

Despite this consensus, and the inherent reasonableness of the underlying policies, MA insurers are pushing back on the AN, often disingenuously. Some plans have even threatened to eliminate benefits or raise premiums in response. As HHS Secretary Becerra told Senators yesterday, any such cost-shifting is entirely the plan’s choice. During a hearing on the President’s FY24 budget request, Secretary Becerra explained that under the AN, “the benefits that Medicare calls for in the law are not changed” and any cutbacks enrollees may see are “because the provider has decided to make cuts in certain areas.” He categorized assertions that plans are being forced to make such updates as “an unequivocal untruth.”

Indeed, plan profit margins and past behaviors, as well as independent modeling, indicate the insurers could operate well within the increased 2024 payment rate parameters or achieve savings internally, without disrupting beneficiary access or coverage.

Industry claims that a $4 billion rate hike is insufficient—essentially, that absent improper overpayments beneficiaries will suffer—while simultaneously spending millions to mislead policymakers and the public, ring hollow. We urge CMS to reject these bad faith arguments, and to instead move forward with beneficiary-centered reforms.

Learn more about the Action Network Initiative’s campaign.

Read their March 14 memo, Changes in Medicare Advantage are Essential for Cutting Fraud and Waste and Protecting Seniors.

Read the press release, survey memo and fact sheet for more information about the recent poll.

Read CMS’s proposed 2024 Advance Notice and the Medicare Rights Center’s comments.