Senate Finance Committee Chair Ron Wyden, D-Ore., has launched an inquiry into potentially deceptive Medicare Advantage (MA) marketing tactics that may take advantage of seniors looking for Medicare coverage.
Wyden on Tuesday released the letter he sent to 15 state insurance commissioners and state health insurance assistance programs requesting data about MA marketing complaints and other information.
"I have heard alarming reports that MA and Part D health plans and their contractors are engaging in aggressive sales practices that take advantage of vulnerable seniors and people with disabilities," Wyden wrote. "I write seeking information about potentially deceptive marketing practices being conducted by insurance organizations offering Medicare benefits under the Medicare Advantage program and the Part D prescription drug program."
The letter was sent in the wake of recent reports from the Centers for Medicare & Medicaid Services (CMS) that it has received more than twice the numbers of complaints from seniors regarding MA plans in 2021 than it did in 2020. Last fall CMS issued a memo that outlined best practices for Medicare marketing campaigns conducted by third parties in response to misleading advertisements.
Wyden also cited a recent survey of state insurance commissioners conducted by the National Association of Insurance Commissioners (NAIC) that noted an increase in complaints from seniors about false and misleading advertising and marketing of MA plans. In May, the NAIC sent a letter to Congress asking lawmakers to give the association the authority to regulate MA marketing. The association cited misrepresentations in marketing, inappropriate or confusing marketing practices that have led to members to enroll in MA plans without understanding the coverage they were enrolling into and disenrolling from Original Medicare, aggressive sales practices, and improper enrollment into plans of individuals with Alzheimer’s Disease or dementia, mentally incapacitated, and those with limited English proficiency.
RELATED: New RISE Association workgroups tackle Medicare marketing compliance issues, KPIs for marketing and sales
RISE has also expressed concerns with marketing compliance practices, particularly the fallout from Medicare television commercials featuring Joe Namath, and last year formed a workgroup to address these concerns. Since then, the workgroup has met regularly to develop a set of recommendations for MA organizations, which it will release to the RISE Association shortly.
RELATED: CMS third-party marketing memo calls out advertising tactics that mislead, confuse MA beneficiaries
The actions of a few “of these bad actors” casts the MA program in a negative light and invites wider criticism, said Kevin Mowll, who chairs the RISE Association’s Medicare Member Acquisition & Experience Community and leads the marketing workgroup. “It stokes cynicism about the merits and virtues of a program that benefits millions of seniors and disabled beneficiaries,” he said. “The most frustrating thing about this is that the bad actors running these TV commercials are outside the regulatory reach of CMS.”
Wyden sent the August 18th letter to state insurance commissioners and state health insurance assistance programs in Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Oregon, Pennsylvania, and Texas. He asked that they provide the following information to his office by September 16:
- Complaints about MA and/or Plan D marketing (segmenting complaints by third-party marketing organizations or TPMO) that they received in 2019, 2020, 2021, and 2022
- Examples of potentially false or misleading marketing materials and advertisements in MA or Part D, including mailers, robo-calls, websites, television commercials, and online advertisements
- Qualitative data on certain types of complaints about marketing materials
- Quantitative and qualitative data on fraudulent activity, such as beneficiaries who were enrolled without any contact with a producer, sales practices like cross-selling, and improper enrollment
- The responsibilities of the agent or broker in the state to protect consumers from potentially false or misleading marketing
- Differences in reports of complaints of false or misleading marketing among groups of Medicare beneficiaries (lower income, dual eligible, Black or Hispanic beneficiaries, and beneficiaries with disabilities)
- Geographic regions where complaints are more common
- Certain MA or Part D product types that may be more likely to complaints
- Misleading information about certain aspects of a product, such as provider networks, provider acceptance of plans, reimbursements, benefits, premiums, cost sharing, supplemental benefits, or other features
- Certain benefits associated with the complaints, such as meals, scooters, $0 cost sharing or premiums, dental services, over-the-counter cards
- Whether enrollment in the products would result in a greater number of prescriptions being filled in a particular pharmacy or pharmacy chain
- Any marketing materials comparing MA and Medicare supplemental insurance products that are false or misleading in nature
- Any trends in complaints of unsolicited contacts of beneficiaries or the methods of contacts, such as telemarketers, SMS texting, online outreach, or online targeted advertising
- Certain types of organizations, such as TPMOs, health insurance carriers, pharmacies, or provider organizations, that account for a disproportionate share of complaints
- Certain parent organizations or other market participants that account for a disproportionate share of complaints
- Certain parent organizations or other market participants that have provided false or misleading materials
- Common MA or Plan D marketing practices that the Senate Finance Committee should know about
Michael Adelberg, providers and plans lead, Faegre Drinker Consulting, who recently spoke about federal marketing oversight at the RISE AEP Medicare Readiness Summit, said that the feedback from the state insurance commissioners could be used to hold a hearing on MA marketing this fall, right before the start of marketing. Congressional attention could, said Adelberg, “push CMS to enforce marketing rules more strictly” during enrollment season.
Meanwhile, the Better Medicare Alliance (BMA), an advocacy and research organization supporting MA, pushed back on the criticism, noting that MA marketing materials are already subject to regulation and must be approved by CMS. “With a 94 percent percent consumer satisfaction rate, it is clear that this program consistently lives up to its promise for seniors, Mary Beth Donahue, president and CEO of BMA, said in a statement. “Policymakers must take action to modernize Medicare enrollment in ways that offer more transparency in coverage choices and empower consumers, rather than criticizing those standing in the gap to help beneficiaries navigate this difficult and complicated process.”