Jayapal, DeLauro, Schakowsky Lead Effort to Reform Medicare Advantage
"Although at its inception the MA program was expected to reduce Medicare spending, MA plans in the aggregate have never produced savings for Medicare. Additionally, inappropriate care delays and denials within MA are harming seniors and people with disabilities," wrote the lawmakers. "Medicare is a foundational piece of the
In the letter, the lawmakers support CMS's proposed rule that prohibits MA plans from imposing any additional burdensome criteria for prior authorization approvals and urge CMS to build on that action and continue to reform MA.
Private insurers in the MA system consistently overcharge Medicare, while inappropriately delaying and denying care for patients. Half of the top 10 providers have been accused of fraud by the
"Medicare Advantage was supposed to reduce costs through better managed care. Instead, the program has become a shameless profiteering scheme for health insurance corporations and is driving up Medicare spending by at least tens of billions of dollars a year. And too many Medicare Advantage plans are wrongly denying and delaying claims and care to people deserve so much better. This letter is proof of the growing recognition of these problems among the public and in the halls of
"Bad actors in Medicare Advantage are delaying and denying care that patients desperately need. CMS has the power to hold these bad actors accountable and level the playing field between Medicare Advantage and traditional Medicare. Seniors and people with disabilities are counting on CMS to take action. We thank Reps. Jayapal, DeLauro, Schakowsky, and their colleagues for fighting for Medicare beneficiaries," said
"Medicare Advantage is neither Medicare, nor an advantage. It is however a cash cow for big insurance and riddled with abuse. I am grateful for the leadership of Congresswomen Jayapal, Schakowsky and DeLauro for pushing these much-needed reforms of a program in desperate need of reform," said
"For far too long Medicare Advantage plans have bilked seniors and the Medicare program by focusing on profit instead of patients. We join with Reps. Jayapal, Schakowsky, DeLauro and the other signers of this letter in demanding improved accountability for insurers who reap massive profits while, among other things, delaying and denying care, maintaining narrow provider networks, using misleading advertising, and cherry-picking healthier seniors while pushing sicker seniors and people with disabilities back to traditional Medicare to get the care they need. It is time to put seniors before profits by enhancing protections, clawing back insurers' ill-gotten gains and reinvesting that money to improve the Medicare program," said
"People's Action members have been organizing to expand Medicare through our Health Care for All campaign for years. We applaud Congresswomen Jayapal, DeLauro, and Schakowsky for taking on Medicare Advantage, a health care scam that increases costs while failing to deliver the care people need. It's time to crack down on Medicare Advantage profiteering and instead work to expand Medicare, a program that we know works," said
The letter calls on CMS to make the following improvements:
1. Finalize and strongly enforce the proposed prohibition on MA plans denying prior authorization requests for coverage of a Medicare covered item or service based on criteria not found in traditional Medicare coverage policies, and issue new guidance prohibiting the use of step therapy for Medicare Part B.
2. Require MA plans to cover services from any medical provider that accepts Medicare's approved rate. At a minimum, require MA networks to cover care at the top 50 cancer hospitals in the country.
3. Stop overpayments by developing a more accurate risk-scoring model based on patient demographics and prohibiting the use of unscrupulous methods to increase care costs.
4. Reinvest the
Jayapal, DeLauro, and Schakowsky led multiple previous efforts in 2022 urging immediate action to stop Medicare Advantage Organizations (MAOs) from improperly denying care to seniors. These calls for action followed a report published by the
The full text of the letter can be found here (https://jayapal.house.gov/wp-content/uploads/2023/02/230216-MA-Letter-Final-with-Signatures3.pdf).
The letter was signed by
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Original text here: https://jayapal.house.gov/2023/02/16/jayapal-delauro-schakowsky-lead-effort-to-reform-medicare-advantage/
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