The House Ways & Means Committee’s Subcommittees on Health and Oversight held a hearing on July 22 to look into the Medicare Advantage (MA) program. NAIFA submitted comments on the issue.

The hearing focused on the popularity of MA—some 33.4 million people, more than half of Medicare beneficiaries—are enrolled in an MA plan. But concerns were raised about upcoding (submitting codes for more expensive treatments than a patient’s actual condition suggested), the high rate of delays and denials of claims related to prior authorization requirements, and the transparency and accessibility of MA plans’ supplemental benefits. Lawmakers and witnesses alike called for improvements to the prior authorization system, strengthened oversight—particularly with respect to upcoding—and enhanced transparency.

NAIFA submitted comments on MA issues that pointed out the urgent need for “beneficiaries to have access to professional, qualified agents to ensure they are making the best choices for their healthcare needs.” NAIFA highlighted its partnership with several field marketing organizations (FMOs) to form a Medicare Collective “that supports policies protecting access to trusted guidance and improving beneficiary outcomes.” NAIFA pointed out that licensed, professional agents educate people on how Medicare (including MA) works, help analyze individuals’ health care needs and their financial circumstances, help people compare networks and benefit structures, provide ongoing support throughout a plan year, and conduct annual reviews with beneficiaries to ensure continued plan suitability.

NAIFA also urged Congress to work with CMS (the Centers for Medicare and Medicaid Services) to require carriers to honor commissions for sold plans, prohibit commission changes after October 1, and ensure the continuation of lifetime commissions. NAIFA also urged elimination of burdensome call recording requirements, a narrowing of the definition of third party marketing association to exclude licensed insurance professionals who are already subject to state regulatory oversight and professional standards, reform of the scope of appointment requirements, and simplification of annual certification requirements by using a comprehensive annual training that would be recognized by all MA and Part D carriers.

Prospects: There is a good chance that if Congress does take up a health-driven legislative package at year-end there will be MA changes included in it. There is considerable bipartisan interest in a range of health issues—including extension of Affordable Care Act (ACA) enhanced premium tax credits, Medicare (and MA) upcoding, and other health issues. However, there is also a deep and bitter partisan divide in Congress and so while prospects for health-driven legislation prior to year-end are reasonably good, such a bill is by no means guaranteed.

NAIFA Staff Contact: Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org