Every year in September the CMS (Centers for Medicare and Medicaid Services) sends out it’s annual review of “all things Medicare,” called Medicare & You. This fall some 43 million copies of this annual guide will land in the mailboxes of U.S. households. But according to this recent PBS News Hour report, three leading senior advocacy groups, after seeing a draft of this year’s guidebook, have spoken out against its accuracy. CMS, they claim, is distorting the facts in order to drive more consumers out of traditional Medicare and into Medicare Advantage plans offered by private insurance carriers.
The Gold Standard?
The PBS report called the publication Medicare & You “a primary resource used by consumers in each year’s annual enrollment season beginning October 15th. As such, it is or should be the gold standard of reliable information for more than 65 million people already enrolled in Medicare and the millions of people who newly enroll each year.” But this year the normally non-controversial release has prompted a backlash. “After reviewing the draft, three groups said [the guide] contained false statements that appear designed to convince people that private Medicare Advantage plans are superior.” CMS, these groups allege, “has unfairly tilted the playing field.”
(If you’re curious, you can download the 2018 version of Medicare & You here and read it online. But before you hit “print,” better load plenty of paper: last year’s book is 136 pages long.)
The three groups making the claim against CMS are the Center for Medicare Advocacy, Justice in Aging, and the Medicare Rights Center. In a joint letter to CMS head Seema Verma, the trio of advocacy organizations said that, because Medicare & You is the core communication vehicle between Medicare and its constituents, it has to be reliable. “It is critical that the information in the Handbook be fairly and accurately presented,” the letter asserted. “Beneficiaries making important choices about their coverage need to be able to rely on the Handbook for unbiased information that they can trust. However, when comparing Original Medicare and Medicare Advantage, the 2019 draft Handbook does not meet this standard, distorting and mischaracterizing the facts in serious ways.”
In response to the letter, CMS issued a non-specific response pledging their commitment to helping beneficiaries make “informed choices.” CMS, says the PBS report, did not address the specific allegations in the letter.
Medicare vs. Medicare Advantage
To help people understand the differences between Medicare and Medicare Advantage, the PBS News Hour report explained some of the basics, starting with traditional Medicare. As many are aware, Medicare Part A helps pay for covered care in hospitals, nursing homes, and other institutions. Medicare Part B covers expenses for doctors, outpatient expenses, and durable medical equipment, but it typically pays only 80 percent of costs. Many traditional Medicare clients also buy what’s called a Medigap supplemental policy, purchased from a private insurer to pay for things that aren’t fully covered by original Medicare. The final piece of traditional Medicare is prescription drug coverage, called Part D. All these components of traditional Medicare are managed by Uncle Sam.
By contrast, Medicare Advantage plans are issued by private insurers, authorized in 2003 under the same law that created Part D drug plans. These plans must cover everything that’s covered by original Medicare, but they often include more: prescriptions, limited dental, vision and hearing benefits and even gym memberships. Because Medicare Advantage issuers usually require policy holders to use doctors and hospitals in their limited network, they usually offer cheaper coverage than traditional Medicare, which permits enrollees to use any doctor or health-care institution in the country that participates in Medicare. Medicare Advantage plans, says PBS, “have surged in popularity during the past 15 years. They now represent roughly a third of all Medicare, with original Medicare holding two-thirds of the market.”
Tipping the Scales
Medicare Advantage plans clearly have their benefits, and CMS has for several years been not-so-subtly suggesting that more Medicare recipients should opt for them, but that bias has become more obvious under the current Administration. The groups criticizing CMS, says PBS, say that the agency is ignoring the fact that traditional Medicare is often the better choice, especially for those with serious health concerns. “CMS,” says the PBS report, “is improperly putting its hand on the scales to tilt them further in favor of MA plans” by making “improper comparisons” between the two options. The groups claim that CMS routinely downplays the possible drawbacks and limitations of Medicare Advantage plans with their narrow group of providers and possible geographic limitations. “At the same time, the draft handbook fails to emphasize that users of original Medicare can use any Medicare-licensed providers anywhere in the nation” – an important benefit for retirees who may be planning to move or who spend a portion of the year in two different parts of the country.
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(originally reported at www.pbs.org)
