The Committee launched its inquiry after receiving information from the Centers for Medicare & Medicaid Services (CMS) that beneficiary reports of inappropriate MA marketing more than doubled from 2020 to 2021. The resulting analysis, based on information from 14 states and other stakeholders, including Medicare Rights, documents this troubling trend. It presents the alarming methods insurance companies, brokers, and third-party marketers sometimes engage in to boost enrollment—and profits—including “deceptive mail advertisements, misleading claims about increasing Social Security benefits, aggressive in-person marketing tactics, and enrolling beneficiaries, particularly those dually eligible for Medicare and Medicaid, in a new plan without their consent.”
Unfortunately, these findings align with our own experience. In recent years, we have seen an increase in calls to our national helpline about problematic marketing. Beneficiaries often report being misled about coverage, costs, and access to providers. Others have questions about predatory outreach, confusing advertising, and involuntary enrollments.
In both direct solicitations and general advertisements, we typically find plans and their agents paint overly rosy pictures of MA, like listing an array of “extra” benefits they may not offer or for which the individual may not qualify. This can cause consumers to mistakenly conclude the benefits are more available and more generous than they are. An October Commonwealth Fund issue brief indicates this is having an impact: nearly 25% of MA enrollees were drawn in by these promises; people with lower incomes, in particular, were more likely to find the extra benefits appealing.
Plan marketers also often fail to disclose the very real tradeoffs with MA, such as networks that may not include chosen providers, delays or denials of medically necessary care through utilization management, and potentially higher costs than might be available through Original Medicare and a Medigap.
Other common techniques include conveying a false sense of urgency, with the intent of spurring beneficiaries to action even if they are satisfied with their current coverage, and designing materials with visual cues to suggest Medicare, and not a plan, is behind the ad. It is not uncommon for our helpline callers to report responding to such outreach only to be enrolled in a plan unknowingly and without their consent.
The Committee recommends five ways for CMS to curb these and other tactics:
We support these proposals and appreciate CMS increasing oversight of MA marketing during this year’s Fall Open Enrollment, as outlined in an October 19 memo. The agency’s decision to review television ads is also very welcome.
To more fully protect people with Medicare, we urge CMS to set and enforce standards for the marketing of supplemental benefits. People with Medicare need unbiased, fully accurate information about these benefits and their limitations. Clear rules would also allow CMS to better oversee marketing materials and verify that plans are not merely using supplemental benefits as a marketing tool but are providing them adequately, equitably, and with reasonable promptness.
We also urge improvements to simplify enrollment, such as BENES 2.0, and greater attention to inaccurate provider directories and mid-year network changes that may leave enrollees without access to their providers of choice.
MA plans are businesses, and their marketing efforts are, therefore, designed to attract new enrollees and maximize profits. From the beneficiary perspective, this can result in an overwhelming number of ads, calls, mailers, and other solicitations that make it hard to know who to trust. The evolution of digital marketing, search engine optimization, and algorithms is making it even more difficult for beneficiaries to find unbiased information about their Medicare choices. Reforms are long overdue.
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