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Medicare Advantage bill introduced by senators to stem complaints

The Medicare & You Handbook is mailed to qualified consumers.

Photo: Susan Morse/Healthcare Finance News

U.S. Senators Maggie Hassan (D-NH) and Roger Marshall, MD (R-KS) introduced the bipartisan Medicare & You Handbook Improvement Act, which aims to ensure that when seniors assess their Medicare coverage options, they have the necessary information they need need care plan choices and additional insurance.

The bill was drafted in part in response to increasing complaints among seniors about aggressive marketing practices for Medicare Advantage plans.

The Centers for Medicare and Medicaid Services acknowledged these complaints in October, saying some of the recent Medicare Advantage ads and marketing materials were “confusing, misleading or inaccurate,” at least in the minds of consumers.

Kathryn A. Coleman, director of the agency’s Medicare Drug and Health Plan Contract Administration Group, recently sent a letter to all Medicare Advantage Organizations (MAOs) and prescription drug sponsors stating that CMS is reviewing the assessment of MA-related marketing materials will improve. Such materials must be submitted under the “File and Use” regulatory authority for MA and Part D drug plans.

She reminded Medicare Advantage Organizations (MAOs) and Part D sponsors that they are responsible for the marketing activities of the agents, brokers and other outside entities with whom they contract.

Hassan and Marshall’s bill aims to improve education materials for seniors during the annual Medicare Open Enrollment period, in response to concerns seniors have shared about inadvertently selecting Medicare plans that don’t best suit their needs. care needs.

“When deciding whether to enroll in a traditional Medicare or a Medicare Advantage plan, seniors rely on the official Medicare & You Handbook,” said Hassan. “Unfortunately, the handbook does not fully address the challenges that Medicare Advantage can create for seniors. My bipartisan bill would address this by improving the handbook and adding important information that is currently missing.”

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Marshall said he has become “increasingly concerned” about mass marketing ad campaigns during open enrollment.

“The Medicare & You Handbook has improved over the years, but it still lacks sharing essential information about health plan choices and supplemental health insurance plans,” he said.


The Medicare & You Handbook is the official handbook that guides new and current Medicare beneficiaries through the Medicare program. The handbook, published by CMS, is emailed to every Medicare household each fall and includes a summary of Medicare benefits, patient protections, a list of available health and drug plans, and some Medicare FAQs.
Specifically, it offers a comparison of Original Medicare and Medicare Advantage. While the handbook has evolved over the years to be more reader-friendly, it lacks information on techniques that help MA control costs, the senators said.

The bill requires CMS to include a description of what use management techniques are, including prior consent and step therapy, and how a beneficiary can find which techniques apply under a specific MA plan or prescription drug plan.

It would also task CMS with including a description of the network size of MA plans relative to the number of providers that accept Original Medicare; and an explanation that when seniors switch to an MA plan and later switch back to Original Medicare, they may be prohibited from purchasing additional coverage or otherwise paying significantly higher premiums.

The bill is intended to supplement the Improving Seniors’ Timely Access to Care Act, legislation that aims to modernize Medicare Advantage and make healthcare more patient- and physician-friendly. That bill — sponsored by Marshall and co-sponsored by Hassan — has the support of 50 senators and more than 500 national and state organizations.

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Hassan also joined colleagues in calling on the Biden administration to implement additional consumer protections in Medicare Advantage following an increase in reports of deceptive marketing practices targeting senior citizens in the program, and joined the New Hampshire Congressional Delegation in calling for Urge CMS to take action to protect eligible New Hampshire Medicare beneficiaries subject to aggressive and potentially predatory marketing tactics related to the sale of Medicare Advantage plans or other insurance products.


CMS reviewed thousands of complaints and hundreds of audio calls and said so numerous problems identified linked to television and newspaper advertisements, mailings and internet searches. The agency called numbers associated with these ads in a “secret shop” campaign designed to track these ads.

“Our secret shop activities have discovered that some agents failed to comply with current regulations and unnecessarily pressure beneficiaries, as well as not providing accurate or sufficient information to assist a beneficiary in making an informed enrollment decision,” Coleman wrote in October. .

CMS has put forward a number of recommended best practices for MAOs and Part D sponsors, including making sure beneficiaries know how to file a marketing complaint with 1-800-MEDICARE or the plan and letting beneficiaries know it’s important to have a ​​agent or broker name, if possible.

It also suggested sponsors ensure that all agents and marketing materials clearly state when certain benefits may not be available to all enrollees.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com



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