U.S. Rep. Diana DeGette (D-CO), chair of the House Energy and Commerce Oversight and Investigations panel -- which oversees the nation's health care industry -- introduced legislation today that will make it easier for America's seniors to evaluate the quality of the various Medicare Advantage plans that are being offered by private insurers so they can decide which one is right for them.
The legislation comes on the heels of an investigative hearing DeGette's panel held earlier this year in response to reports that some Medicare Advantage beneficiaries faced significant barriers when trying to access the medical care they needed.
The Medicare Advantage Consumer Protection and Transparency Act, co-led by U.S. Reps. Katie Porter (D-CA), Lloyd Doggett (D-TX) and Jan Schakowsky (D-IL), would better protect consumers by holding insurers that offer Medicare Advantage plans more accountable for the coverage they provide. It would also increase transparency of such plans so beneficiaries know exactly which services they offer.
"As more Americans enroll in Medicare Advantage plans, we need to make sure these plans are working for them," DeGette said. "By improving transparency, this legislation will make it easier for consumers to choose the plan that's right for them. It will also hold insurers more accountable to ensure our seniors are receiving the coverage they deserve."
The legislation will require insurers to provide consumers with clearer and more accurate descriptions of the services they offer. It will also improve data collection related to each insurers' coverage -- including their claims and denials -- and require that insurers make that information available to the public.
"Insurers that provide older adults with subpar care should be held accountable--and we need to have the data to do it," said Porter. "The current system we have allows Medicare Advantage plans to escape scrutiny, depriving older Americans of the care they need and cheating taxpayers out of what we all pay for. Our Medicare Advantage Consumer Protection and Transparency Act will empower watchdogs and lawmakers to verify that Medicare Advantage is working as well as it should be."
"The promise of Medicare for American seniors and individuals with disabilities is for comprehensive, affordable, and quality health care--not for taxpayers to consistently pay more and more for less and less care," said Doggett. "The Medicare Advantage Consumer Protection and Transparency Act will provide important transparency to understand whether Medicare Advantage provides any advantage at all. Following alarming reports concerning high rates of denials of care, limited provider networks and inaccurate directories, and failure to report encounter data used to assess quality and frequency of care, better transparency is vital to protect taxpayer dollars and ensure beneficiaries are receiving comprehensive care. This legislation requires extensive data disclosure on supplemental benefit design, consumer cost-sharing expenditures, denials of care, and encounter data."
"I am extremely concerned about Medicare Advantage plans that too often use deceitful practices. Seniors deserve quality, transparent health care," said Schakowsky. "During a hearing in the House Energy and Commerce Subcommittee on Oversight & Investigations, we learned that Medicare Advantage (MA) plans have deceitfully made seniors seem sicker than they are so the plans can line their own pockets. These "upcoding' practices accounted for $12 billion in additional payments to MA plans. Meanwhile, these same MA plans deny coverage and use delay tactics to prevent seniors from accessing much needed care. I am proud to co-lead the Medicare Advantage Consumer Protection and Transparency Act. This bill will require MA plans disclose data showing how much care seniors are receiving and how often they are denied coverage. It will also require MA plans disclose information on their supplemental benefits. Seniors deserve better!"
The Medicare Advantage Consumer Protection and Transparency Act is endorsed by some of the nation's leading consumer advocates -- including Public Citizen, the National Committee to Preserve Social Security and Medicare, Social Security Works, the Center for Medicare Advocacy, Just Care USA, and the Center for Health and Democracy.