U.S. Senate report: Medicare Advantage uses deceptive advertising to scam seniors.

My art is on Instagram @klonskyart.

Yesterday Anne and I attended a Chicago a meeting at the Hyatt Regency downtown held by Illinois Central Management Services, Illinois TRAIL (a state retirement insurance program), and Aetna Insurance.

CMS has just switched our TRAIL from United Healthcare to Aetna/CVS.

There was a power point and explainers and a time for Q and A. But the explanation of transition was complicated with lots “answers to questions can be found on our website.”

I kept wondering why the privatized Medicare Advantage program that is our only option as a public employee retiree is so complicated while Medicare is so much simpler.

For example, I am in the middle of a biologic therapy for Crohn’s that continues past January 1st when Aetna’s MA takes over. I was required to get pre-authoriation for the therapy that costs $4,000 a dose. Aetna representatives assured me that Aetna would follow United Healthcare’s decision to okay payment for the drug. But I have scheduled an infusion shortly after Aetna takes over in January.

What if there is a screw up? Some bureaucratic problem? The drug must be administered at exactly the right time. There is no room for error.

Most certainly other retirees are in a similar situation. It is a source of worry and stress for many.

And why is a medically required, doctor authorized therapy subject to pre-authorization from a a for-profit insurance company?

Medicare doesn’t require pre-authorization.

Speaking of privatized Medicare Advantage.

A Senate Committee has issued a report criticizing the Medicare Advantage industry for deceptive advertising aimed at the elderly.

The Centers for Medicare and Medicaid Services (CMS) revealed earlier this year that the number of Medicare beneficiary complaints about private sector marketing for Medicare Advantage (MA) plans more than doubled from 2020 to 2021.1 The Senate Finance Committee Majority Staff (hereinafter “Committee”) launched an inquiry in August 2022, collected information on marketing complaints from 14 states and found evidence that beneficiaries are being inundated with aggressive marketing tactics as well as false and misleading information…

The Senate Committee concluded:

…we are seeing that marketing practices by private plans (or their agents and brokers) need to be reined in: bad actors are trying to cash in by taking advantage of loopholes and loosened rules around marketing and enrollment to beneficiaries – badgering seniors on the phone, confusing them on television, and inundating them with mountains of mail. An increasing number of marketing materials are fraudulent or deceptive, undermining beneficiary access to care and trust in the Medicare program. Of particular concern to the Committee were reports of vulnerable seniors’ and people with disabilities’ health plans without their consent. CMS has broad authority to regulate the marketing and enrollment activities of MA and Part D plans. Congress may need to step in, as it has in the past, but this report identifies a number of commonsense changes CMS could make to protect beneficiaries today.

Of course Aetna is a marketer of a number of Medicare Advantage programs in addition to our state program.

They are also one of the bad actors.