Medicare open enrollment season is supposed to be a time when enrollees can choose the best coverage based on accurate, unbiased information from the federal government. Unfortunately, the Trump administration’s enrollment tools show a continuing bias toward private Medicare Advantage (MA) plans over traditional Medicare.
This is not surprising. The Centers for Medicare and Medicaid Services (CMS), under its current leadership, seems to behave as if its main priority is to privatize the Medicare program.
Making Medicare coverage decisions is a complex task with multiple personal considerations. Beneficiaries need help understanding their options — including the pros and cons of traditional Medicare and private Medicare Advantage. They need to make fully informed choices given their existing and projected health needs, financial circumstances, and potential assistance with cost-sharing. In a 2018 poll of our organization’s members, more than half of respondents said they make enrollment decisions through online research.
Traditionally, Medicare enrollment materials have been neutral regarding the two basic types of coverage. But starting in 2018, advocates noticed that the public outreach (including its Medicare and You handbook) seemed to steer enrollees toward Medicare Advantage by overemphasizing the positives of private plans while downplaying the negatives, and limiting — or outright omitting — references to traditional Medicare. As David Lipschutz of the Center for Medicare Advocacy noted, the handbook characterized Medicare Advantage as “less expensive by default” and listed “prior authorizations” for certain types of care as a “benefit,” rather than an impediment, for patients.
Under pressure from advocates, the Centers for Medicare and Medicaid Services revised the handbook to mitigate some — but not all — of these biases. Fast-forward to the 2020 open enrollment season: the handbook is somewhat improved, but CMS’s online enrollment tools remain slanted toward MA plans.
When enrollees visit the Find a Plan feature at Medicare.gov, they can click a button to explore coverage options. The next screen asks, “What type of 2020 coverage are you looking for?” The first choice is “Medicare Advantage Plan,” followed by Part D prescription drug plans and Medigap supplemental insurance. The list of options does not even include traditional Medicare, which covers 66% of all beneficiaries. A new enrollee could be forgiven for not knowing that the original program signed into law in 1965 still exists.
Only by clicking “Learn more before seeing plans” and entering a zip code do visitors see an option for traditional Medicare, which CMS refers to as “Original Medicare.” Neutral language informs enrollees that the traditional plan includes Part A hospital insurance and Part B medical, but that beneficiaries must purchase drug and supplemental insurance separately.
Below that is a blurb touting Medicare Advantage as an “all-in-one alternative to Original Medicare” that offer “extra benefits — like vision, hearing, dental and more,” which sounds more like advertising than straightforward information. In fact, during the 2019 open enrollment season, CMS sent emails to millions of older Americans encouraging them to choose Medicare Advantage. “Get more benefits for your money,” said one message. “See if you can save money with Medicare Advantage,” implored another.
(Editor’s note: The Centers for Medicare and Medicaid Services did not immediately respond to a request for comment on whether its tools favor Medicare Advantage.)
It’s fair to ask: Why does it matter if official enrollment information favors Medicare Advantage? While MA may be a reasonable choice for some younger, healthier seniors, it has some built-in disadvantages compared with traditional Medicare. Medicare Advantage offers a limited network of health care providers. Provider networks can change from year to year with little or no warning. Patients may not be able to see their preferred doctors or specialists. Specialist visits may require troublesome pre-authorizations.
Unlike traditional Medicare beneficiaries, MA enrollees cannot purchase supplemental Medigap coverage to help with copays and deductibles, which sometimes can be costly — and often unaffordable. If patients develop chronic or serious health issues as they age, and wish to switch to traditional Medicare, they may not be able to obtain Medigap insurance to help cover out-of-pocket costs, because those policies are not guaranteed to be issued six months after a beneficiary first enrolls in Medicare.
Medicare Advantage was created with the belief that the private insurance market could deliver seniors’ health care more efficiently than the traditional program. But MA plans have proven to be less cost effective than traditional Medicare. In addition, Medicare Advantage insurers have been caught overcharging the federal government to the tune of $10 billion a year. Meanwhile, HHS audits have raised concerns that Medicare Advantage patients have been denied appropriate services, potentially causing “physical or financial harm” and representing a “misuse” of federal Medicare dollars. Taxpayers pick up the bill, while the Trump administration continues to push Medicare Advantage on new enrollees.
We and other senior-advocacy groups have called upon the administration to level the playing field between traditional Medicare and MA plans. Instead, the president issued an executive order in October effectively doubling-down on that bias. The executive order requires federal agencies to examine regulations and practices to make sure that traditional “Medicare is not advantaged or promoted over [Medicare Advantage] with respect to its administration.” In other words, the executive order aims to solve the exact opposite problem of the one that really exists. It will intensify — rather than mitigate — the bias toward private plans and against traditional Medicare.
Alarmed by the administration’s lack of objectivity, our organization joined forces with the Center for Medicare Advocacy to provide the public with objective, accurate information about enrollees’ options. Unlike the administration, our goal is not to steer enrollees toward one program or the other, but to make sure they are positioned to make the best possible choices. Advocates will continue to press the Trump administration to level the playing field, but we may have to wait for a new president to prioritize public good over private profit in the Medicare program.
Max Richtman is president and CEO of the nonprofit National Committee to Preserve Social Security and Medicare, promoting the financial security, health and well-being of older Americans. He is former staff director of the U.S. Senate Special Committee on Aging.