Ron Wyden Leads Senate Finance Committee Hearing On Medicare Advantage Annual Enrollment

this morning the finance committee gathers to discuss an emerging Trend in Medicare Advantage Marketing middleman now there's a long history of ripoff artists in the private sector trying to take advantage of seniors who depend on their Flagship health program Medicare since I served as the Director of the Oregon gry Panthers something like a year or two ago these un ethical salespeople would often sell seniors 10 or 15 separate unnecessary Medigap policies that weren't worth the paper they were written on Senator dashel Senator hin Senator Dole and I came in and we pretty much drained that swamp the same thing happened at the start of Medicare Advantage in fact I think my colleagues were there uh then chairman Bach has held a hearing on Medicare marketing because scamers were actually going door too in the South wearing white coats and stethoscopes around their necks to try to persuade seniors to enroll in these plans we got a few protections but it wasn't enough last fall I released a report that detailed some of the most outrageous marketing practices I've seen in Medicare Advantage like Vans parked outside senior centers with Medicare splashed across the side and mailers designed to look like IRS documents many members of the committee join Senator Casey and I and calling on the centers for Medicare and Medicaid services to make changes to protect beneficiaries from these slimy tactics CMS moved and moved quickly just yesterday they rejected more than 300 ads because they were just so fraking outrageous and misleading at the time we also said we're not going to take any Victory laps as seniors experiened medicare's annual open enrollment that started 72 hours ago our invent investigators found that marketing middlemen are the latest set of SE sleazy private sector Scoundrels targeting seniors on Medicare Advantage now we've got Bad actors again gearing up this time for the new enrollment period so let's talk about who these people actually are and why they're such a big deal in Medicare Advantage they are big private marketing companies and they get in the middle between seniors and their health care coverage these big marketing companies jump to get in front of seniors and they especially want to do it during the annual open enrollment period and what these middlemen are doing is hijacking personal information from as many seniors as possible and then they funnel the personal information to the health plans that pay these sleazy marketers the most money basically we're going to describe this as a profit for these companies first help for seniors and taxpayers last now some seniors information gets passed multiple times from one money grubbing hand to another the marketers will sell seniors data once if they can they'll sell it twice if they can they'll sell it as many times as possible the wheel of Deceit friends just keeps going round and round ripping off seniors ripping off taxpayers the seniors are the ones left Getting badgered By Phone targeted on the internet stuck with mountains of mail and ultimately a plan that may not meet their needs to sum it up the marketing middlemen have made seniors their product and they are trying to sell as much of the product as they can now it's also taxpayer dollars that is in effect lubricating all this and these dollars line middleman's Pockets Insurance experts have told us that marketing costs taxpayers $6 billion in 2022 alone put your arms around that6 billion taxpayer dollars went to marketing middlemen who may have sold your elderly parents your grandparents or your neighbors the wrong plan it's outrageous it's a ripoff it's got to stop and that's why we've had our investigators launching a further inquiry because we believe there's additional information with respect to these slimy practices one other quick issue and then I want to yield to my friend Senator kpo we're also in a related effort to stop what are called ghost networks now a year and a half ago nobody knew what a ghost network was but a ghost network is what it sounds like somebody buys a mental health insurance policy and they expect they're going to get some services but after they buy it after the contract is signed and they actually need it The Ghost Network basically has no there there you can't find a doctor you can't get information about uh what hours of service they might keep there's just nothing to follow up on certainly nothing resembling the health care services you thought you bought so our investigators looked at a cross-section of mental health plans across the country they contacted the providers they asked if they could get an appointment for a family member they were were able to get an appointment 18% of the time so more than 80% of the time their plan actually failed them even if a senior could make an appointment with provider and get and get this they may be exposed to extra costs if they have to go to a provider out of network in other words they paid for something there wasn't any service they need some Health Services they go out of network and the person they gave the money to originally sticks them with the second bill so we got a lot of work to do and I just want to particularly commend my colleagues Senator Bennett and Senator Tillis like Senator kpo and I and the finance committee we try to be uh bipartisan they've introduced a good Bill I'm pleased to be a co-sponsor of try to make sure that seniors will get more accurate data about these um services and we tell some of those ghosts they're fine to run around on Halloween but they're not uh going to be a able to rip off seniors the way they've been doing last point will be this over the years I've come to believe that one of the pieces of the health care puzzle that is not getting enough attention is the role of middlemen today we're looking at marketing middlemen I'm very appreciative that uh Senator kpo has joined me in another effort with senator staban supporting our colleagues here and that's going after the pbms because there again you have middlemen in effect you know insurance companies taking you know big fees High salaries rather than getting that money to patience now as Senator kpo and I have described these middlen are not cut from a cookie cutter they're not all the same but I think it's important to be looking in the future at this I intend to do it we spend 4 trillion do a year on healthc care cost folks and we can get more value for those $4 trillion in one of the areas I'm going to be looking at are these middle men and I'm very appreciative of Senator crpo joining me not just in today's project but also in the PBM Senator crpo thank you Mr chairman this hearing comes at a crucial time as millions of Americans evaluate Medicare coverage options during the annual open enrollment period during this window seniors and many Americans with Disabilities have the opportunity to select a Medicare Advantage or ma plan that best fits their needs I have long championed Medicare Advantage for its success in leveraging Market driven competition to offer patients access to a wide range of costeffective coverage choices the vast majority of our ma plans cover services not available under traditional Med including for dental vision and hearing Health needs with consistently High satisfaction rates and low premiums Ma's Market dynamism serves as its strength not as its weakness that said the complexity of the Health Care System poses significant challenges for Americans from all walks of life including those enrolled in MA plans seniors need clear credible and accurate information to navigate the coverage and service landscape fortunately a variety of resources and tools can help guide Medicare beneficiaries through the decision-making processes this opaque system requires however the federal government's Medicare Plan finder a decision support tool outlining coverage choices can prove cumbersome and confusing often displaying out of date or otherwise inaccurate data as we consider options to ease enrollment we we should assess solutions that improve plan finder by integrating more relevant information and enabling more userfriendly navigation furthermore we should examine opportunities to empower effective insurance brokers who serve as key community-based resources and access points including in the context of n ma plan enrollment through Common Sense patient protections and targeted transparency we can promote a vibrant and competitive broker landscape assisting seniors while preventing deceptive marketing and other problematic practices practical guard rails however cannot come at the expense of patient privacy or a functional marketplace with all policies under review we have an obligation to consider both confidentiality concerns and administrative burden I look forward to hearing thoughtful ideas about how to improve the enrollment process by better aligning the incentives and increasing transparency with common sense consensus-driven and market-based solutions we can ensure broad access for seniors to all of the tools needed to make crucial informed coverage decisions thank you very much Mr chairman I I thank my my my my colleagues we have uh called an audible and moved seats uh here just uh Mr chairman I'm sorry my coffee attacked the chairman just a moment ago and so we were moving down to get out of the way so sorry may it was something personal I know actually we didn't like what you were saying sen so we were no I I it was the coffee I told my friends my father would say this is not going to be one of the Great Moments in American history we have survived it all okay we've got terrific Witnesses here Senator Brown's in attendance and uh he and I go way back in terms of fighting for senior rights and uh so appreciate his leadership and he's going to introduce our guest from Ohio thank you very much Jo yeah pull it up embarrass me in front of my H State constituent um our morning did did the coffee get into the microphones I don't know it may have it's a plot thank you thank you Mr chairman uh Miss R good to see you it's my pleasure to to introduce Miss Christina regg who's currently the program director for the the renowned Ohio senior health insurance information program so-called osip osip provides education and counseling to assist older Ohioans in choosing the best and the most affordable health and prescription drug coverage plans for themselves and for their loved ones Miss r r began her career at the Ohio Department of Insurance as an OIP training officer went on to work as a training supervisor and assistant director prior to becoming program director about two years ago she oversees the program's grant funding operations management Outreach and education efforts and consumer service and conseling under her leadership OIP has received National recognition for the high quality services it provides to Ohio's nearly 2 A5 million Medicare benefici were a state of 12 million uh the importance of those 2 and a half million people in the services you provide are really important uh she was selected to sered on the national uh ship steering committee from 2012 to 2018 she served as a as chair for the last four years of that period uh Miss RG thank you for your commitment to making Ohio to making enrollment easier for Ohio Medicare beneficiaries thanks for helping them get better coverage and save money thank you for joining this committee today I look forward to hearing your testimony thanks so much I think I thank my colleague and m r my mother always used to say after basketball games dear just make sure tonight you're running with the right crowd you oh high 's in the right crowd we're glad glad you're here thank you Senator Brown our next guests will be Kobe Blumenfeld gance uh Mr uh Blumenfeld gance is CEO and co-founder of chapter a technology enabled Medicare and retirement platform previously he worked at paner Technologies got undergraduate degrees the Wharton School in the University of Pennsylvania he holds a masters in public policy from the University of Cambridge we very much uh welcome you sir and look forward to your comments and then our Final witness will be uh Christa hogland uh Chief Executive Officer of security health plan been there since 2021 security health is part of the Marshfield Clinic uh health system in man Marshfield Wisconsin and she is the executive uh serves on the executive committee of the board of directors of the alliance of community uh health plans and she's also an actuary so we thank all of our Witnesses this is an important hearing we're going to uh have everybody take five minutes for oral testimony we got plenty of questions and M reg let's start with you good morning chairman weiden ranking member kpo and members of the committee thank you for the opportunity to appear before you today my name is Christina regg and it is an honor to be here I am the pro progr director for the Ohio senior health insurance information program or OIP at the Ohio Department of Insurance we are one of 54 ship programs that are funded through a Federal grant to provide objective and unbiased information to individual uh on Medicare their family members and their caregivers ships provide local and unbiased information to empower the consumer to make an educated and individualized decision decision regarding their prescription drug and health insurance coverage 2023 marks my 26th year with OIP so I began as the boots on the ground traveling Ohio's 88 counties 29 appalation uh providing one-on-one counseling about Medicare part A Medicare Part B and at the time maybe metag Gap this month our program began counseling Ohio is now 2.5 million Medicare beneficiaries to help them make educated DEC decisions for 2024 coverage We Now operate in a hybrid model providing information and education both through virtual and in-person um events that we advertise through social media paid and earned media and Grassroots efforts the information that we present now vastly differs from my early years with osip many of the counties that we Council in there are more than a hundred health plan options for us to review most Medicare beneficiaries won't review or change plans because the task of comparing is too daunting to help narrow the field we do use medicare's plan finder tool this web-based tool allows us to determine if their current prescription medications are covered outline all out-of-pocket cost and plan details but it does not include the plan Network it rather links to the plan's website the company websites can be difficult for Medicare beneficiaries to navigate alone we use that as a launching point we then ask the consumers to reach out directly to their providers that they are not willing to give up and ask very pointed questions right down to the contract number to make sure they can continue to use those Services counseling Ohio's lowincome and limited health literacy Medicare population brings added challenges these individuals are more apt to join a plan solely for the added benefits specifically the over-the-counter allowances and other cash rewards many are applying for the extra help or medicare's assistance with prescription drug cost for the first time even when the application is automatic there are delays which can lead to affordability issues at the pharmacy window ships assist by getting them into temporary programs like Linette to help curb those costs also special enrollment period for low-income individuals are often misused putting consumers into managed care plans more frequently than the quarterly allowance osip's assistance is often reactive in those situations when the beneficiary has found themselves having difficulty receiving needed medical care or prescriptions in my time with OIP I have seen extreme growth growth with the Medicare population growth within the scope of ship work and extreme growth with the plan options our Medicare consumers are overwhelmed by the volume of options in each County they're flooded with marketing material and often confused by the variance of plan details networks in these added benefits the desire to have benefits you're entitled to or added benefits often masks the need to look at critical plan data such as the specific cost the networks and other restrictions they may encounter this often leads to poor enrollment decisions and undesirable outcomes Medicare beneficiaries would benefit from additional oversight a personalized annual notice of Change Would assist beneficiaries in better understanding changes such as higher costs from year to year stronger oversight on the utilization of special election periods such as the lowincome or emergency special election periods and a block on enrollments for those with cognitive impairments could could minimize improper sales to the most vulnerable beneficiaries reinstatement of measurable differences when approving plan contracts would help contain the volume of plans in each County these actions could help make the process of choosing and enrolling into a Medicare health plan less intimidating I am happy to answer any questions and remain dedicated to this population thank you thank thank you very very much and I go way back with your organization the Oregon chapter so great great to see you Mr BL chairman widen ranking member kpo and members of the committee thank you for inviting me to testify and for dedicating time to this important topic my name is Kobe bloomenfeld gance and I'm the CEO and co-founder of chapter a technology enabled Medicare and navigation platform I started chapter because the Medicare enrollment and navigation process is broken and consumers deserve better fighting deception and improving the Medicare experience is personal to me my parents were the first two people at the chapter helped and they're the reason I started this company they needed help fixing mistakes they made following the advice of a broker who had no obligation to prioritize my parents interests over his own my parents experience of confusion and costly mistakes is the norm not the exception choosing the wrong Medicare Plan can add thousands of dollars of extra cost for consumers and it can even make life-saving medications unaffordable before I more of the challenges facing Americans on Medicare I want to share chapter's unique approach to guidance which has afforded us insight into what consumers are up against chapter is a consumer first Medicare navigation platform the breath of Medicare choices is overwhelming to most but with good data and tools choice is empowering we've invested Millions into building a Medicare data and Technology stack from the ground up to recommend the right plan tailored to each person's needs our exceptional engineers and Medicare advisers are dedicated to demystifying medic Medicare for every American but it shouldn't require worldclass data scientist to help an American choose their Medicare insurance we've upended status quo in incentive structures in The Brokerage model we consider the full scope of Medicare options from every carrier and then we recommend the right one even when we earn no money we operate this way because no consumer should enroll in a sub-optimal Medicare Plan simply because their broker earns a commission consumers are more likely to wind up on the right Medicare Plan when their advisers incentives are aligned with their own every American who enrolls in Medicare deserves to do it with Clarity and confidence I wanted this for my parents I want it for every person who works with chapter and I want it for myself someday here's how we get there better data ending deceptive marketing and prioritizing consumer interests consumers deserve significant improvements in the quality and availability of data specifically on provider networks benefits and prescription prices without these consumers along with the organizations trusted to guide them will will continue to struggle to make informed choices CMS sponsors some of the tools with the greatest potential to help like Medicare dv's Plan finder and their published data files these valuable resources are widely used by the industry and by state health programs but if Americans need support making a fully informed decision these tools are not enough for example plan finder cannot help a consumer understand which plans let them keep their doctors and there are limits to the information on how much a prescription will cost on each plan consider a consumer who sees three doctors they might need to compare over 100 separate searches across each insurance company's webbsite it is not reasonable to expect a typical consumer to conduct this search insurance carriers owe it to Consumers and to the industry that supports them to provide open accurate provider Network and other benefit data via API how can we expect consumers to make informed Medicare related decisions when they lack the data and tooling to do so chapter has worked hard to solve this problem for consumers but it has been an uphill battle accessible transparent data is the first line of defense for any consumer making Medicare decisions among a barrage of misinformation last year this committee published a report on deceptive marketing and I commend the committee's ongoing focus on this topic every fall Medicare eligible consumers are bombarded with mailers tv ads and phone calls Rife with misleading and pernicious content the Bad actors are typically not local brokers who live in each Community rather they are lead generators operating as marketing middlemen who traffic in Scare Tactics imitate government agents and inaccurately advertis plan benefits CMS proposed regulations to prohibit the transfer of consumers personal information from one marketing middleman to another this would have been a welcome change but these updates were excluded from the final rule this year at chapter we've trained our experts to help consumers distinguish between scam Medicare ads and real government information but the fact that we have to do this is an indictment of how Brazen some Medicare advertising has become the current Medicare brokerage model is broken because there are no legal requirements for stakeholders to prioritize consumer interests the way we do a chapter this hurts consumers and it hurts the reputation of the Medicare program Brokers should be held to a higher standard of contact and accountability Brokers could be required to consider all plans when making recommendations agencies could ensure that their salespeople are not incentivized to push plans that pay higher commissions if we can commit to transparent data honest tactics and putting consumer interest first we can help Medicare live up to its promise thank you for your time and I look forward to to your questions thank thank you very much and I I want you to know um I took notice particularly of your statement that we missed out this time on the rules with respect to marketing middlemen that's going to change and I thank you um Miss Hogan chairman widen ranking member Creo and members of the committee my name is Christa hogland and I'm the chief executive officer for security health plan a provider aligned plan that is part of the marfield Clinic Health System it is my honor to be here today to discuss this important topic of protecting Medicare beneficiaries prior to my current role I served as the Chief Financial Officer and chief actuary at security with nearly 20 years of Actuarial experience including working on Ma bids and on a personal note I am familiar with the consumer side as well as both of my parents are security ma enroles today I'm here to share our experience about competition and marketing practices in the Medicare Advantage Market security health plan has offered ma for Two Plus decades proudly serving more than 60,000 beneficiaries today this year for the first time a majority of all Medicare eligible beneficiaries use Ma for their coverage and it is growing quickly in popularity CMS estimates next year there will be an additional 2 million more ma enroles compared to this year however in recent years enrollment growth has not been evenly distributed among plans in the most recent open enrollment period 2third of national enrollment went to just two large National for-profit companies we very much appreciate the attention this committee and CMS have paid to the issue of appro inappropriate marketing aimed at seniors but more must be done while consumers get information from many sources when choosing a Medicare Advantage plan the single most influential perspective does remain Brokers we value the important role Brokers play in efforts to Ure our efforts to educate our Consumers sell our products and support our members local Brokers are a trusted partner for security health plan and health plans across the country in fact 85% of our ma enrollment at security health plan comes from our more than 500 Brokers that we are very proud to partner with unfortunately we know some large firms and thirdparty marketing organizations leverage their influence for financial gain rather than what's in the best interest of the consumer many of these field marketing organizations receive add-on or incentive payments that go above and beyond the CMS approved broker commission caps instead of collecting the maximum Commission of $611 for a new enolly many Brokers are collecting $1,300 or more this additional compensation is marked as marketing administrative dollars and in can include all kinds of um you know additional add-on fees but besides that this creates an environment in which beneficiaries and ultimately the Medicare program itself are paying out billions and unnecessary dollars these aggressive marketing techniques have real world consequences just last week in a conversation with one of our trusted broker partners he described the Ambush that had already begun ahead of open enrollment which is technically not allowed um with his clients receiving as many as five or more phone calls a day and his team is barely able to keep up with their existing customers answering their questions making sure they understand what those calls are about let alone seek to support new enroll that might be interested in in enrolling in MA in a previous Medicare open enrollment period our team assisted a senior who was tricked into enrolling in another plan we worked with the consumer to reenroll in the security health plan product not once but four times in a single open enrollment period these aggressive tactics make it more difficult for smaller regional health plans like security health plan to compete less competition between ma plans means less pressure to keep cost low and less Innovation this is a disservice to beneficiaries and taxpayers I urge you to engage with CMS to review the practice of add-on broker payments to ensure that unfair practices are inhibited especially total payments above and beyond the CMS caps further CMS and Regulators must remain Vigilant in enforcing marketing rules that protect seniors from misleading and aggressive marketing three immediate changes that can be made to ensure that Brokers remain sufficiently compensated for assisting beneficiaries we're also ensuring that that Health Plans utilize Medicare dollars to compete for enrollment based on benefits and quality are first of all standardizing and limiting total compensation um so rather than you know a commission a total compensation cap thinking about creating um incentives for enrolling beneficiaries and high quality and value-based plans and finally transparency in requiring total broker and third party marketing um compensation so that we can all understand all the dollars that might be flowing through these mechanisms chairman weiden ranking member crepo and members of the committee again I'm honored to be here creating a well-functioning ma program that protects beneficiaries and supports them in making well-informed decisions is crucial to the long-term success and sustainability of this program I thank you for their time this morning and welcome the opportunity to answer questions thank you all very much and this of course arrives it's such a crucial time the start of the Open Enrollment season let me start with you miss hogland you gave us an example of what amounts to a a jaw-dropping ripoff you basically said that some of these plans are paying $1300 or more for a new enrol e is it right that when you add all of these extra costs all of the costs heaped onto the system by these middlemen this comes to somewhere in the vicinity of $6 billion yeah I would say that that estimate might might even be low um I mean truly um I think it's really important that we're recognizing the amount of dollars that we're talking about here they are quite significant at the benefits of perhaps you know lower costs for taxpayers um or additional benefits for enroles um so as I said that that maximum Commission of $61 per new enrol but we're continuing to see um you this growing Trend in paying these field marketing organizations these middleman as you call them um all kinds of additional fees you can call technology fees referral bonuses marketing health risk assessment and on and on and on um the list of creative add-ons um continues to grow and so this has really become um sort of an arms race and creating this anti-competitive environment where you know to to my colleagues Point here that that folks aren't necessarily being enrolled in the plan that's right for them they're being enrolled in the plan where the incentive um lies that's the largest and the reality is is we want competition in the system based on coverage I I'm thinking my friend and I worked together back in 2009 we had a bipartisan bill and Senator stabenau was with us on it as well that would have put the competition in terms of who would get the best for their Healthcare Dollar in terms of coverage and uh and options and that leads me to my last question for you the way we sto the ripoffs in traditional Medicare and I mentioned you know when I was director of the great Panthers I'd go to a senior's house and they'd go to the back room and be kind of embarrassed and bring out 10 15 policies that weren't worth the paper they were written on they had these fancy subreg Clauses and you basically got nothing the way we drained that swamp is we had some core standardized principles around which uh traditional Medicare is offered there's competition but it's competition based to coverage not who can win the arms race is that really what you're recommending here yeah absolutely we want what you want which is um you know sort of fair and equal competition but that competition ultimately is what is best for our seniors and making decisions based on the benefits offered right not the the financial incentives so you characterized it as an arms race paint the picture of what would happen if nothing is done supposing the Congress just says we're very busy we don't have time to deal with it and they're making a good point over there in finance but we got a lot of stuff on the on our plate I share your view I think there will literally be a Healthcare arms race but paint the picture of what that would look like yeah I mean I think the first thing is we can we would continue to see add-on payments as I mentioned there already is a lot of creativity about what what these things can be called and I think we continue to see that number grow and grow um if there's no um no caps or additional transparency and then ultimately that starts to inhibit competition as um smaller Regional plans in particular are not able to afford to keep up um in that arms race and continue that to make these add-on pay payments and so I I think that ultimately it does uh lead to less competition and um not things that are in the best interest of the the beneficiaries Mr Blumenfeld gance just a question for you about ghost networks and you know my 10-year-old is always wondering why I'm always talking about ghosts and you know the point really is 6 eight months ago nobody knew really what this was about but this is about as Stark a ripoff as I can imagine because if say somebody in the audience or a family member buys a policy that they think will give them essential mental health kind of services and then they go to get them they find that nobody is there there aren't any providers and you don't get any information and services and there may not even be a directory in terms of where to where to go why is this so serious you've looked at this I know uh in considerable detail tell tell the committee why it's so serious there are a few aspects here uh and and it is a really serious issue I think there are gradients of how this plays out in practice on the one hand on the far side as you're alluding to there are um networks that just don't exist that are straight fraudulent that is not legal today it's an Enforcement issue not a policy issue um because that is not allowed based on on the rules um but there's a there's a really complicated gray area in the Middle where you have networks that do exist um but there are no open opportunities for patients to schedule appointments um for a host of reasons either because the providers are over overbooked and and understaffed or um because uh the tooling isn't sufficient there are a host of reasons um but I think e even from the uh well-intentioned perspective when when there is good intention it can still be very challenging for consumers and so U when we look at additional policies or regulations that we we could consider certainly better enforcement of the true ghost networks um that just should not exist and there should be better better enforcement there um but I do think there's an issue as well of Provider networks that do exist but are just really hard to access great Senator crpo thank you Mr chairman protecting seniors privacy should be a top priority during the enrollment process because Medicare and Social Security numbers can be used to file false claims or enroll beneficiaries in plans without their consent Federal Regulation prohibits marketers whether calling on behalf of a plan or a third party from asking beneficiaries for this information however a recent survey of seniors over the age of 65 found that 10% of all respondents were asked for their Medicare or social security number Mr bloomenfeld Gant outside of the formal enrollment process is there a time when a broker or marketer would need a beneficiary's Medicare or social secur security number there should not be what are some of the challenges that the federal government faces in forcing the current guidelines and what additional steps should the administration take to conduct better oversight in order to protect the beneficiary's privacy and to prevent fraud thank you uh as as I alluded to in my in my opening statement there were proposals to make it more difficult for middlemen to sell and transfer data to multiple consumers um and I think that is a really helpful step um that would essentially make it illegal for a middleman to sell the same consumers data to multiple additional middlemen multiple third parties at the same time which is the status quo it's legal today and it's what happens today and that's I think one one big step we can take um another big step we can take is making it easier to have more transparent information online the status quo right now is that it's very simple from a regulatory perspective to provide information over the phone it is extremely onerous for third parties and good actors including chapter to provide that information online it's much easier to provide it over the phone based on the regulatory framework and I think that should be inverted all right thank you that's helpful Miss hogland in your testimony you stated that one entity alone cannot reasonably educate all current and potential ma beneficiaries about their plan choices I also agree that Brokers play a very important role in helping many seniors navigate their choices to find the plan that best fits their need you mentioned that Brokers are responsible for 85% of social health plans ma enrollment can you expand on your company's partners with Brokers to better serve your beneficiaries how you better partner with Brokers to do that yeah so appreciate the question uh so you know there as you know that the open enrollment period is a relatively short amount in time and for a health plan of our size to be able ble to service all those enroles that we'd like to and that period of time is just not feasible so we do be believe strongly in partnering particularly with our local brokers who again in most cases want the same thing we want which is to put the consumer in the Pro in the product that's absolutely planned that's best for them um and so we do um educational events to to make sure that our our communities um the brokers in our communities understand what we can offer um how those might compare to other options uh and make sure that there's education on an ongoing basis um we also make sure that the regulations are communicated what's allowed and not allowed in terms of practices and we're very particular in who we partner with um making sure that again that the Brokers are aligned with us and making sure that they're committed to following the CMS regulations that are out there around how they interact with our our beneficiaries so we're very fortunate that your plan is very responsible and if we could get every plan to do the same we wouldn't have a lot of the troubles we're talking about here today how should CMS and Congress uh balance protecting seniors from fraudulent or abusive actors while also helping plans to ensure that they continue getting the education and support they need to make these decisions yeah so I'll just say that um you know we certainly have shared the same concerns um with CMS that we're sharing um with this committee today and they have been very interested and understanding um and are I think committed to helping uh address this problem in the same way that this committee is and we certainly think um bipartisan support um today would would be something that would be very valuable and helping them move and take additional steps around um addressing uh areas where there is abuse um or mis misuse um you know we continue to partner when we have specific examples of as well of where um someone has not followed the regulations and making sure that CMS has that ongoing awareness this so that they are in a position to address it all right thank you very much I'm I'm going to go to senator staban now in just one second I also noted miss hogland that you talked about your sense that it is these big plans you talked about two big plans that are the bulk of the problem and there are a lot of people at the local level Brokers and others who work with you and the like I want to I'm not going to take more time because this is Senator staban now's uh time but I'm going to want to follow up with you on that thank you stab well thank you Mr chairman really important question that you just asked um and I want to thank you and our ranking member for holding this very timely hearing particularly because we are now the beginning of the annual enrollment period for Medicare and so I do want to St by just stressing that the good news is that in this enrollment period 65 million Medicare enroles seniors and people with disabilities will see new savings on prescription drugs thanks to the successful Democratic efforts about a year ago such as $35 cap on insulin which is so important free vaccines and inflation cap on Medicare Part B drugs like Cancer Treatments that I know the chairman championed and we appreciate your effort and we're also seeing Medicare begin the process the first 10 uh prescription drugs will be negotiated in terms of lowering price which is a long long overdue but at the same time during this time why we're here today is that it's critically important that beneficiaries get the coverage that's right for them and that they're they think they're signing up for that they think they're paying for and not get deceived into selecting coverage that doesn't allow them to access um the best uh and most important services that they want and need I think it's really important also to know that because being involved in this neg uh initial discussion about should we open Medicare to Medicare Advantage should we the private sector for profit businesses wanted to be a part of Medicare there was an argument around lowering costs or providing more benefits we now are paying 4% higher rates for Medicare Advantage than what is paid for under traditional Medicare and it that makes it even more concerning that we're seeing $6 billion in taxpayers funds being used to pay for marketing middlin or Miss hogland as you said it may be more actually we don't know for sure on this but it's even more concerning given the fact that Medicare Advantage is already receiving a bonus to participate and be a part of the Medicare system I'm particularly concerned about situations as as my colleagues have said where people are seeking out particular uh benefits special benefits dental vision hearing other additional Behavioral Health Services and then they find out if they sign up that they really aren't getting the care that they need and I wanted to speak specifically about and ask a question about Mental Health Mr R um because one out of four Medicare recipients as we know have a behavioral health condition either mental health issue or uh addiction issue and many of them aren't able to get the care that they need that's been particular focus of mine for a long time but we know that there are so many barriers put up under Medicare Advantage plans um and we heard about those today prior authorizations required re uh referrals and so on I remember discussing when we did the Affordable Care Act and offering the amendment to make sure that we had parody that you couldn't do that that you couldn't do that under a and yet still happening and now we have President Biden coming out with additional rules they want to enforce on this whole question questioned um but these things are still happening particularly through Medicare Advantage so when you're counseling someone to find the best plan for them um how do you help them understand those barriers how do you find out about uh the barriers particularly when it comes to Mental Health Care it involves that individual conversation and really getting to know our community um and the individuals that we're serving with regards to Mental Health I think you spoke accurately on the need to know the network and making sure that there is availability prior to signing up for the plan additionally where a lot of consumers Miss um the education piece is knowing if there's a prior authorization situation where they have to have a relationship with their primary care physician as a gatekeeper to that Specialty Care and those are things that the ships can help assist in Ohio our ship physically sits at the department of Insurance we're very fortunate that we're also home to the mental health insurance Assistance office and we can collaborate to make sure that we've extended additional education to those consumers thank you I I would just say that I still am so concerned in in general when we look at mental health or Addiction Services somehow Special Care rather than just the Continuum of Health Care Healthcare above the neck should be tree the same as Healthcare below the neck it should be Healthcare and so by we we start with barriers for people um and so I think at this point my time is up Mr chairman but thank you very much and well well said by my colleague who is the point person in the United States Senate for advocacy for mental health and we appreciate her comments Senator Cortez mastal is next thank you thank you Mr chairman to the ranking member and all the panelists today for this important conversation I have to say you know in NADA as of October of this year uh roughly 50% of nevadans eligible from Medicare are enrolled in in in MA plan um this is such an important issue for my State uh and and as we're hearing of course we need to better leverage transparency tools across Medicaid programs including Medicare Advantage um with the enrollment as we're hearing and spending growing I am actually working on legislation that will help policy makers and researchers um assess the value of these that these plans deliver to over 30 million Americans uh for today's hearing though I I do want to focus a little bit on the importance of transparency for consumers so miss RI I have heard from nevadans including in staff in my own state in my own office who are trying to help their parents uh and they are trying to enroll in Medicare coverage for the first time they meet with a broker or see an advertisement about Medicare Advantage plans offering Zer premiums and boundless uh supplemental benefits sounds good sometimes too good to be true uh are are advertisements like this misleading and if they are what what should federal government what should be be doing about it they are and this has gone on for years we in all of our public presentations and our counseling we beg the consumers do not choose your health your prescription drug coverage based on an advertisement the advertisements will focus on the Zero premium zero co-pay at a primary care um maybe no Co pay for generic medication but we really want them to look at things like what is the co-pay for inpatient hospitalization per day and when it comes to Medicare Advantage also know that maximum out of pocket which would be a limit to their Financial Risk so the advertisements over the years have gotten more aggressive and they do focus on those added benefits specifically cash allowances debit cards money to go into the local drugstore and purchase items that aren't covered and and we have counseled numerous individuals especially over the past open enrollment year they were very upset with us because we could not use medicare's plan finder tool to order the plans in order of the highest debit card to the lowest um and when we try to Circle back to things like their specific providers um mental health needs and other critically needed Services they really want to focus on those ad benefits and that has been a challenge for us due to the advertisements so is there and I understand the federal government's recent steps to to curb deceptive marketing help seniors sign up for Medicare coverage is that helping can you see some of that we are cautiously optimistic we'll know more as um plans go into effect in 2024 personally I've seen a bit of a difference in the commercials that are aired on television and the online ads but there's still um you know and I get it consumers with limited incomes limited resources to have that those added dollars each month for groceries or utilities is a a need but if we can focus on the critical need which is their health care and their medical needs it could hopefully rivert them into plans that are best suited and would your recommendation of stronger oversight on utilization of special election periods such as lowincome um uh impair excuse me lowincome subsidy special enrollment period in the block uh on enroll ments for those with cognitive impairments would that help if we were provide more of that over I would agree with that thank you Senator thank you and then uh uh Miss hogland broker fees this is an issue for me as well and I just it it it astounds me that this uh is happening but I'm not surprised I am not surprised anytime There's an opportunity to make a profit you're going to see people trying to take advantage of that um I'm very curious how how do the Brokers earn these extra incentive payments and are some of them consider you know what we're hearing now junk fees I mean what what what's going on here yeah so um I would say the the the add-on fees really do vary significantly and some you know perhaps there could be some value to um you know an fmo you know the middleman we're talking about they have some you know administrative cost right to be set up in an ongoing business um but when we hear things like they're being paid for health risk assessments we don't see a lot of value in having an or a broker complete an H for with a member um that's not something that we can get the data and really use it um and so there are more and more of those types of things where we don't see there being true value it's just how what creative way can we come up with to shift more dollars um to to you know to incent enrollment in certain plans so thank you and I know my time is up but uh Mr chairman I I too I I think we need to address not just the deceptive marketing but we're seeing with the broker fees uh the goal here is to make sure this is not as complex for seniors so they can access it and keep more money in their pockets uh and not uh some other Predator who was out there so thank you my my colleague as usual is way too logical and heaven forbid as we talk about these administrative costs and going back to these gray Panther days we always were talking about it I fail to see how six billion in marketing costs and Medicare Advantage is a reasonable allotment for Administration so we're going to work closely with you and look forward to hearing more about your bill um next in order of appearance would be Senator Langford Mr chairman thank you thanks to all the witnesses and uh for your ongoing work and for being here in your preparation today on it I really do appreciate it I am like a lot of other folks uh my family is taking care of elderly parents and um medic Ma has been a huge asset to us uh because it keeps everything all together we're able to help manage all that and to be able to go through the options on it so I'm one of many folks that are grateful for it but also have questions uh on how it actually operates and and how things actually work the medical loss ratio uh piece about this and the gift cards that we've already talked about and such where that actually gets listed and how plans actually file that as medical expenses um gets a little iffy in the process Are there specific things that you could share that you would say we can solve some of this by just not allowing the gaming of the system of how they Define these gift cards and things and what they apply for to be able to make sure people are actually focused in on the health care side of things rather than on the free cash side of things is that a definitional issue that we need to resolve and I'm fine with anyone who wants to take that on um I I would say I appreciate you pointing out there right there technically is a limit on what is supposed to be spent for on administrative costs um but I I think think um this is where I'd say that more transparency to to your point perhaps a better definition on what our administrative costs what truly our benefit costs could be very helpful um and then um anytime you require that transparency making sure there are enough audits to verify that folks are completing as intended um and not getting creative with how they complete the forms okay any other suggestions on what that definition could or should be thank you for the question I think about this as really a combination of health and and financial expenses um many people when they're enrolling in a Medicare Plan do have to make both health and financial trade-offs and so the question is how do we make it more transparent to Consumers the all-in cost the all-in um health health uh coverage that they're getting um and whether those dollars come out of part A or Part B or part C or part D um with regard to the plan um and which which budget allocation I think is is secondary to the consumer but probably very important to the um to the system okay I want to drill down a little bit more on what Senator Cortez master was talking about the advertising we've got advertising is one thing things that are coming in online or on the television it's another issue when I've got seniors that literally every single day get a call day after day they're getting calls on it um that that is they're they're Furious about it obviously um but again this is a business that's trying to be able to reach out to potential customers we also have that that we want to be able to maintain the options and the awareness of it how do we strike a balance on that because my seniors are are sick of all the calls coming in on it if I may our seniors are sick of it too when we are at public events they approach us afterward with their phone saying how do I make it stop and we ask them you know they're on the D not call list that's not enough and Ohio also is home to I think over a quarter of million um independent agents that want to do right by their consumers and that's not where these calls are generated from it's often the lead agencies and these third parties and I believe if the plans were held accountable for the actions of those middlemen those entities it might curb some of those calls okay what would that accountability look like I think punishments for the plans um whether it impacts their star rating on the Medicare tool um or financial penalties that would be determined up above okay uh let me let me follow up another question on this uh Medicare Advantage and this takes a little bit off topic on this but the issue with some of my rural hospitals especially they're getting more more frustrated with the denials that happen uh just an automatic it's going to be denied so trying to get the pre-authorization in process so that they're not going to have denials or to be able to have a predictability in the process what we're see seeing is literally in my state we have some Hospitals now that just won't take Medicare Advantage period they' just cut everybody off and said we can't do it because we can't afford the constant chasing for all the denials so that is exactly the opposite of what we want to be able to create here what are you hearing on that and what are alternatives that you would see and so I appreciate the the question in particular we serve um a very rural population um and and our goal is always to partner I mean we're part of an Integrated Health System so I think that really helps us in thinking about the provider's perspective when it comes to a variety of issues in including prior authorization as you mentioned um but we spend a lot of time making sure we work closely with our rural facilities it is absolutely imperative right that our seniors can get in for care when they need it and that we're not putting up unnecessary barriers to necessary care um so this is a priority for us to make sure that we're partnering um you know particularly in those rural areas where there's not a lot of options so that our our seniors can get in for care when they need it okay thank you chairman rank member thank you for holding the hearing on this but this is something we've talked about before with if they're on a provider list but they're actually not a provider that's out there that's frustrating in many ways but if you are a provider and you're told that Medicare covers this and you just get an automatic denial for it every time that also disincentivizes them to be able to be a provider so I do think we need to work on both sides of this issue as well important Point Senator Grassley is next my turn yes okay um I'm sorry I missed your testimony because I had to be in the budget committee also dealing with something with Medicare and Medicaid I'm going to start with Miss rag a couple questions I've heard from Iowa independent agents and Brokers about the new federal requirements to record all phone calls with seniors and to store the audio files for 10 years so can you you say is this the most effective way for federal Regulators to conduct oversight and are there more effective ways to ensure quality thank you Senator uh while the ships are impartial and focus on the Medicare beneficiaries the patients the caregivers as a ship that sits within insurance I know that was a struggle for many of the independent agents um to take on that added request for recordings and as shared previously those typically aren't the Bad actors it's often times large Brokers um activity that happens out of state um that is consequential for our Medicare beneficiaries ending up in the poor plans I believe recording the calls from the lead agencies the thirdparty marketing and the out ofate Brokers may have had an impact I'm unaware of if there have been results or data taken from that um I'm not sure it was effectual with the independent agents uh another question for you in addition to the current Medicare open enrollment Medicare Advantage enroles can change plans or switch to original Medicare in the first three months of the year this was added in 2016 currently this open enrollment is not available for Medicare Part D plans I have told me that sometimes their Medicare Part D PL Pharmacy Pharmacy benefit manager switches the tier placement of a patient's drug uh during the plan year this change can increase the patients out of uh a pocket cost is this the common is this a common problem and should there be an additional open enrollment period for Medicare Part D yes uh ships I believe would support that so we have the Open Enrollment every fall October 15th to December 7th ideally in a perfect world every Medicare beneficiary would accurately review their Health and Drug options and be in the best plan come the new year however we often have to use January February and March to review different Medicare Advantage plans and we don't have that option for the individuals that are currently in original Medicare with the Standalone plan uh Miss hogland uh Medicare Advantage enrollment continues to grow as a percentage of Medicare enrollment when I led and passed the 2003 Medicare modern ization act 5 million seniors were enrolled in Private health plans today it's 30 million why are seniors choosing to enroll of Medicare Advantage plans compared to the original Medicare I appreciate this question I I agree I mean I think um Medicare Advantage is an undeniable success um and offers a pretty high quality um coverage to to a lot of Americans um it is uh one of the only Federal programs that measures and Rewards high quality so I think there's an element of that um that that um beneficiaries can see what plans are considered high quality um and that that is something that's an advantage over um other other programs um it also I think can be a very valuable program for Rural populations and underserved populations and so I think that's another reason um perhaps why we've seen some of the success um as was noted earlier um definitely the additional benefits are are also some things that really do appeal to our seniors and can help with um more well-rounded support for all of their needs not just their medical needs perhaps some of their their social determinance as well yeah uh Mr Bloomfield uh question about pbms for you uh they uh can have a significant impact on a senior's access to prescription drugs and how much they cost at the counter where they get their drugs how does your company help seniors navigate challenges created by pbms so seniors can access a local pharmacy of their choice at chapter we look at every single Part D plan and every single prescription and every single option of where someone could fill that prescription that data is unfortunately not available online the the government does not publish it insurance carriers do not publish it chapter is the only organization in the country where you can actually get accurate information on where to find a prescription at a specific price on a specific Medicare plan that should be true it unfortunately is so what we do is we look at all of that data and we recommend a plan that minimizes costs given someone's prescriptions and given any potential prescriptions they may they may need to take throughout the year yeah and for you and Miss R this question what steps have your organizations taken to ensure that rural Americans receive quality And Timely information there we go um for the ship program we rely on Partnerships um Partnerships with the local area agencies on Aging Partnerships with faith-based organization uh Partnerships really with anybody that'll partner with us in those communities to disseminate information timely and accurately uh to those populations just as we would those in our metropolitans Mr bloomfeld uh I think it's really important that we continue to provide more information to consumers so that they can make these really difficult decisions I think without that and without better regulation oversight over Brokers themselves um there won't be much improvement thank you Mr chairman I thank my colleague next in order of appearance would be Senator Blackburn oh thank you Mr chairman and uh I am so pleased we've got a hearing today on the ma program and uh I I find it so interesting that for the F first time most Medicare beneficiaries have selected an MA program and it really has marked a shift I think in the thinking of our Medicare enroles from fee for service over to a value based system and um Miss hogin I want to come to you first uh in your testimony you talked about ma enrollment growth not being evenly distributed through the marketplace with a concentration in a few National companies so I want you to drill down on that a little bit about how you see this affecting the overall competitiveness of the ma program and what changes would you suggest we look at as we try to um promote competition yeah so so um absolutely this is a a huge area of concern as we talked about earlier I think competition and Medicare Advantage um is what's best um it's what's best for the consumers it's what's best for the federal government in terms of spend um you know in particular on on this topic you know what what can we do um I would start with with transparency um transparency in all of the dollars that are flowing um over and above that that CMS cap because we do think that's a lot of what is driving the beneficiary Choice it's not necessarily what's in the best interest of the consumer but where those dollars are flowing and so I think it would be very interested interesting to track that data and see with transparency around total payments is there a correlation between those dollars and where we see the enrollment lining up um and then the second thing uh there would be once we under understand and have transparency to talk about true maximum caps um that Encompass not just commission but total payments um and so again then then we're we're making sure that folks aren't aren't using Financial incentives and it's really about placing the the benefici here in the in the plan that is the best fit for them and then finally Thinking Beyond about you know how do we make sure that that is directed towards high quality plans um and that sort of thing okay you touched also on some of the aggressive and misleading advertising in the ma space so a couple of questions there can you give us some specific examples on impacts on seniors and uh what you're seeing there and secondly uh for people that have been enroles have you conducted satisfaction surveys to know what they saw as being aggressive and misleading yeah so um one of the things that we do is we watch our disenrollment um you know we stay right on top of those and we often will follow up with consumers when we see those come through and and it's you know fairly often that that our seniors weren't even aware they were switched um so that's how aggressive the tactics are um and they're not even understanding it might be as basic as a you know how would you like to have your groceries covered and the person says yes and pretty soon they're switched that was the key so they have no idea that that the question is leading to them being switched on a plan um we have um as I mentioned uh in my testimony um a trusted partner who said you know ahead of open enrollment when they're not even supposed to be allowed um they're their clients receiving five six you know seven calls a day um and so you know just the the you know call after call after call and they're spending a lot of time trying to help re-educate um their consumers on you know this is what you have this is why we think it's right for you okay so it is some of those uh consumer protection items that you're wanting to see enhan uh Mr bloomenfeld gance I do have a question for you but I'm almost out of time and I know others want to ask their questions so let's have you do this one in writing and submit it I would like to know how you see what you see is the differences between chapter and other Medicare ad um advisors and then with it being a tech enabled platform how do you address the needs of older enrollees and allow them into um into your program and with that I will yield back Mr chairman thank you Senator Blackburn thank you for your question Senator Mendez thank you Mr chairman uh CMS has recently implemented changes to rein in misleading Medicare Advantage Marketing practices yet marketers are finding ways around these requirements as a matter of fact the the number of uh complaints that have been filed nearly double a recent Commonwealth fund survey found that 10% of respondents report that marketing callers would ask for their Medicare or social security number which is not permitted under Medicare law uh further while cold calling is specifically prohibited three out of four respondents reported receiving unsolicited calls Miss Hogan what should e CMS be considering to step up enforcement and hold Bad actors accountable yeah I I think that's a a great question and you're you're absolutely right uh that that despite um some some new guidance and we we talked earlier there has been you know Improvement in some spaces but we're certainly seeing um in many spaces the aggressive tactics really continue um so I mean having having CMS be in a position to respond quickly as these are reported I think is is really a critical piece um which you know we believe they are um I just will we'll share um you know we we continue to hear from our our broker Partners on an ongoing basis that this is a an issue their clients are getting called um we know sometimes sweep sweep Stakes or contests are used as a way to get them in the door and so folks not even maybe understanding that they've actually have given their information out um and so that's another tactic that we hear that's being used um that perhaps could be addressed all right uh because this is a particularly potentially vulnerable class yes uh now miss regg uh is it regg or R reg regg okay uh as you know state health information and Assistance programs known as ships are trusted sources of information for many seniors and people living with disabilities these ferally funded resources are tasked with educating and assisting Medicare eligible individuals through Outreach counseling training and specifically support lowincome individuals those with disabilities and individuals who are duly eligible for Medicare and Medicaid given your experience as a program director how could providing more resources to ship uh support efforts to protect low-income individuals and those with disabilities that would certainly support the added um counseling that we've been doing for that particular population um in Ohio many of our lower income individuals are going through the redetermination some signing up for Medicare for the first time or enrolling in the lowincome subsidy and need extended counseling and assistance to get sometimes into temporary drug programs to curb the high costs so our counseling for that population is taking longer in addition our population has grown the scope of options and benefits has grown and we're trying to keep up with that we're fortunate to have our base Grant funds and Priority One for mppa funds but it's it's not keeping up with growth additional funding could support that uhuh and I'm troubled by reports that vulnerable individuals particularly lowincome and dually eligible individuals are being Target targeted by deceptive marketing tactics and are often enrolled in plans that just simply don't meet their needs what else can be done specifically to better support these populations and ensure that the care that they need is the one that they get for ship programs many of us utilize direct entry into medicare's complaint tracking module or ctm um and as I shared earlier a lot of times we're reactive they're already in a plan that's not a good choice for them and we're trying to get them either back or into a plan that is a good choice if the plans were required to include the agent on record in those complaints it would help us with the investigatory aspect of it we're a ship again that sits within the Department of Insurance the only regulatory Authority that the states have really is on agent activity and it would help us Identify some of the Bad actors finally Mr blumthal uh Blumenfeld um we know that seniors often find the process of selecting their coverage to be confusing difficult U overwhelming uh I was looking at it now that there's open enrollment and uh I'm not sure that even as someone who is pretty well versed in some of this would know how to make the best decisions uh many Medicare beneficiaries RI on a broker to assist them with choosing their coverage almost one in three people ages 65 and over said they use a broker or agent to help them choose Medicare coverage yet they still often very don't end up in plans that that are best for them what what do you think consumers should know about making their plan decisions first Brokers are not required to put consumers interest first and I think that needs to change we operate differently at chapter we do put consumers interest first but that is by far the exception and not the norm uh so I think it's important for consumers to know what the incentives of their advisers and their trusted guides are um and then I think there's a whole host of data challenges that need to be solved to make sure that the information is available to Consumers so they can make informed choices because today it's very challenging thank you Senator uh Senator Hassen is next thanks Senator Bennett uh thanks to the witnesses for being here today I really appreciate you and your work Miss hogland I want to start with a question for you uh as we've heard today Medicare Advantage plans are an important option for individuals on Medicare who are looking for more comprehensive benefits such as prescription drug coverage Vision hearing and dental it's essential that we preserve this option for seniors but we also need to ensure that plans are fairly and accurately representing their benefits I have unfortunately heard too many concerns from constituents with Medicare Advantage plans who are unable to afford the medications that their doctors prescribe while Medicare Advantage plans often advertise comprehensive benefits many people are not explicitly told as we're hearing today by marketing agents that their plans do not include prescription medication benefits even for Medicare Advantage plans that do include those benefits patients sometimes don't get appropriate information about whether or not their medications will be covered or if the coverage will change so my office recently heard from a constituent in North Conway she has a Medicare Advantage plan but it has scaled back her prescription drug coverage she uses several medications to treat her autoimmune disease two of which were originally covered as preferred tier one drugs under her plan with a low copay however the plan partially stopped covering the medications a few months later after she had already signed up which added to her financial benefit uh burden and she previously had a different Medicare Advantage plan that repeatedly denied her coverage for a third medication that she's relied on for more than a decade to manage her autoimmune disease forcing her to rely on samples provided by her physician too often consumers feel that the Medicare Advantage plans overpromise and then they under deliver on results now you Miss Hogan is the CEO of a small Health Plan with a good record know what it is to do this well and right how can we best ensure that these big plans provide the benefits that seniors need what would you recommend we look at yeah so I I appreciate this question um so certainly you know I can't speak to the specific example but you know we've heard stories like this before I mean one of the things that we're committed really committed to is making sure that we maintain a comprehensive and affordable list um and really about working with the individual to address right if there is a change in formulary but their provider you know indicates that this is a necessary drug or there's concerns about side effects for transitioning we really work with the individual to make sure that they maintain coverage through an exception process um and so you know perhaps there could be some more work around how how could that exception process work better to make sure that um that there's consistency across plans right um the other thing that we talked about a little earlier is um it would a large enough change and the prescription benefit perhaps be um something that could trigger an option for them to select another plan um because currently that may not be the case got it thank you so much um Miss regg I also recently heard from a constituent in Bedford New Hampshire who unfortunately has experienced the kinds of marketing practices that we've heard about uh in the hearing today this constituent cares for her 26-year-old son who has a developmental disability and is eligible for Medicare her son was on traditional Medicare but a Medicare Advantage Marketing agent called his cell phone and got him to agree to switch his insurance this company took advantage of him during a five-minute conversation leaving him with a plan that would not F fully cover his health care needs the good news is that his family found out about it the same day and was able to undo the changes just in time but unfortunately there is nothing stopping as we've heard this kind of unscrupulous marketing uh for these plans and nothing stopping them from targeting the most vulnerable patients who may not have the resources that they need to navigate this kind of conversation so miss regg how can we prevent these kinds of tactics from impacting our most vulnerable populations I agree I'm sorry to hear that story but it's a story we hear time and time again we've counseled um individuals both under 65 on Medicare due to disabilities and individuals over 65 but with extreme cognitive impairment and the record that we're able to view on Medicare system through Marx shows an enrollment almost every month which is far exceeding what the low-income subsidy special enrollment period allows so we do file um the complaints and I think again knowing who that agent on record would allow us to take a step further on in the side of enforcing those rules right thank you very much and and thank you Mr chair thank you Senator Hassen for your questions um the good news for all of you is I think I'm the last person but I have a few questions that I wanted to ask Miss re let me start with you Medicare Advantage plants have grown in popularity over in recent years over 50% of Colorado seniors have selected ma plans over traditional uh Medicare while this private insurance provides seniors with more options we need to provide appropriate oversight and protect seniors from deceptive marketing and properly Steward taxpayer dollars and I think that's why we're all here today I've heard from hospitals across Colorado like the St Louis Valley Health about the challenges they face to get their patients timely care with Medicare Advantage plans consistently hospitals and their patients experience hospital admission denials delays in care and plans refusing to pay after they've approved a service in fact the head of St Louis Valley Health Connie Martin told me that in the past 6 months the hospital has made 45 Hospital admissions requests from ma plans and every single one of them was denied this is in stark contrast to a 93% approval number uh across other private non-medicare plans this is utterly unacceptable and I plan to follow up with the plans directly plan to follow with the plans I have that plan we have to follow up with the plans and she was actually quite specific about who the folks were and I think we're going to have a conversation but our seniors deserve better than this K Rodin with Medicare Advantage consistently tell me that my office that their surgeries are delayed often for months that they were lied to about their level of coverage or that their plan was too expensive and that their claims are denied when they're told Services you know should have been or would have been covered all of this demonstrates I think that we need greater transparency and so miss regg as a director of a state insurance department do you have access to Medicare Advantage plan denial rates or approval turnaround times and if you had access to that data how would that change your ability to guide seniors toward the plan that is best for them and their health care needs thank you Senator uh at this current time no we do not have access to that level of information um having access to that detailed information and accuracy rate would greatly help us in choosing plans for consumers and allowing them to have confidence and peace of mind when enrolling into those plans thank you for that answer and I've got a a follow-up question for you m re colars with C Medicare Advantage plans often don't recognize that their private plans don't cover their doctors until it's too late in 2018 the centers for Medicare medication Services reviewed 52 Medicare Advantage plan directories and found that over a third of of providers were erroneously included either because the provider did not work at the listed location or because the provider was out of the plans Network these are often known as ghost networks ghost networks make it difficult for a beneficiary to determine if their doctors are in network at all and this misinformation often leads to unex expected and higher out-of-pocket costs for Colorado seniors and that's why I've worked with my colleagu Senator Ron weiden and Senator Tom Tillis to introduce the real Health Prov providers act which will strengthen requirements for these private Medicare Advantage plans to maintain adequate provider directories it would also ensure seniors do not pay out of network costs for appointments with doctors who were inaccurately listed out of network MRE when you help Council seniors as I know you do how important is it for them to know that their current doctors are actually in the network and do you feel confident telling them that the private that the provider directories they rely on are accurate and network information is vital to choosing a plan um as shared earlier no we don't rely on the directory or even the plan finder link to the company's website page uh we use that as a springboard for them to work directly with their provider offices to see if they are in specific Medicare Advantage plans Network information not just in network versus out of network but also knowing if there's a prior authorization to utilize Specialists um are hurdles that we often go over with Medicare beneficiaries I do think you I have I'm at an end so I'm not going to ask my third question I'll submit it for the record but I appreciate your testimony very much to me this is just one more place where seniors are having to spend their Golden Years fighting fighting fighting just to get the health care that people in other countries you know have relied on and that's when it comes to Medicare which is something that people generally I think feel pretty good about uh in our country so thank you we're going to fix this problem and I really appreciate your testimony here today Senator Casey uh you're next I'm going to turn it over to you thank you thank you Senator Bennett I want to thank the witnesses I I was at another hearing so we had a a conflict to so I didn't hear your testimony but I'm grateful for your willingness to be here today and to to testify about these important issues M re I'll I'll direct both my questions to you um in your testimony you mentioned the kind of information and marketing tactics that quote often lead to poor enrollment decisions and undesirable outcomes unquote Medicare as we all know is a promise and here's the basic promise guaranteed access no questions asked guaranteed access to healthc care after a lifetime of hard work unfortunately that promise is not often not U often enough uh fulfilled despite This Promise which everyone every member of the United States Senate and House is bound by despite this promise we know that many older adults and people with disabilities still have a hard time getting quality coverage because they're either conf confused by the enrollment process or influenced by misleading marketing or both ensuring that there is both clear information and accurate information about enrollment and different uh Health Plans is the very least that government can do uh so that Medicare eligible individuals are appropriately educated on how to make the most of their uh earned health care benefits that's consistent with keeping the promise I've introduced the so so-called Benny's 2.0 act the beneficiary enrollment notification and eligibility simplification act with Senator young of Indiana the bill would provide advanced notice to individuals approaching Medicare eligibility as well as timely information on when to sign up for Medicare so here's my question how important is the role of ship counselors like yourself in ensuring Medicare beneficiaries can make the best decisions for their needs we feel it's vital we provide objective and unbiased um no one affiliated with the ship program can have a financial gain um or a conflict of interest in dealing with the information that's going out there we provide that and unfortunately we see the same just this month we were working with a gentleman that was a undergoing active cancer treatment and he got a phone call and enrolled in a different managed care plan and that none of his specialists were involved in and we were able to get him back into his other plan and back on his plan of care we appreciate the work that you do and I'm I'm also concerned about that a question um that has arisen I know in in a lot of these discussions is that um ships may not have the resources they need uh to meet the growing demand due to growing demographic Trends and other challenges Medicare funding to ships and other resources for low-income Outreach and enrollment efforts may be in Jeopardy because it was not included not included in the recent continuing resolution how can you speak to the needs uh for continued resources for ships given the demands and challenges you're facing in the implications for low-income older adults if funding is not extended this year I think it's important to note that the ships are very good stewards of federal funding uh the return on investment with both volunteer counselors and the hours that they put in and the dollar saved um by enrolling consumers in the most costeffective plans signing up for the low-income subsidy or extra help with their prescription drugs and the influx of assisting consumers with applying for Medicare Savings programs uh far outweighs the dollars that are included in the current Grant models but the growing population the growing scope and the demand in every state would warrant the additional dollars well thanks very much and thank you for your testimony and now I'll turn it over to Senator Warren all right thank you Senator Casey so this week millions of people will begin the process of choosing a Medicare Plan through open enrollment and one option is to stay with tradition addtion Medicare the other is to enroll in one of the many Medicare Advantage plans or ma as uh uh people often refer to it which allows these for-profit health insurance companies to offer Medicare coverage now in theory these private companies should compete on the merits of the coverage they offer instead big ma insurers with a war chest of advertising money use deceptive marketing tactics to lure seniors into the wrong plans these companies exaggerate benefits uh they claim that seniors can keep seeing doctors that are actually out of network and they deceive seniors about how much they'll spend for out of pocket care this is harmful to seniors and that's a big part of what this hearing today has been all about but I want to focus on a different point it also drowns out competition from smaller insurers even when they offer a better product so miss hogland you are the CEO of security health plan this is a small community-based plan that participates in Medicare Advantage so can you just let's start with how does your marketing budget compare to the marketing budget for example of United Health or Sigma Well I obviously don't know the specifics of of um what that number might be but I can can tell you it's it's Pennies on the dollar fraction fractional of what we would have to spend so everybody's out there trying to sell their plans to people and some folks have got huge marketing budgets and you've got a little sliver of that so where do these big insurance companies get the budget for all of this advertising well think about the structure here the government pays ma plans a set amount of money per beneficiary if a beneficiary is sicker then the amount of money that the government pays can go up and then whatever the insurers don't spend on care they get to keep in profits now as a result of this structure giant insurance companies have built an entire business around making beneficiaries look as sick as possible by stuffing their medical records with as many diagnosis codes as possible which which mean the government pays insurers more money this is called upcoding and government Watchdogs have uncovered hundreds of billions of dollars in overpayments that result from insurance companies gaming the system like this Miss Hogan are Medicare Advantage plans permitted to spend the money they make off this upcoding on advertisements there's sorry there's some amount of discretion um in how the the dollars can be spent um I I do want to say I really do appreciate this question um and how you framed it and and we would agree with you that it that we should be competing on the merits of coverage not on you know the the financial incentives um we certainly believe um at security health plan around care not coding and with care as the focal point and I am very glad to hear this because my understanding is these plans can spend about 15% of the money they get from the federal government these are your tax dollars at work uh on overhead and marketing and nothing prohibits them from using the payments they get from gaming the system to actually draw more people in so they can keep that practice up so the way I think of this is the Medicare Advantage plans that gain the system get billions of dollars in overpayments they then turn around and use that money to flood seniors with deceptive ads to lure them to join their plans but there's one more twist in this once people sign up once the companies make them look as sick as possible these giant insurance companies refus to deliver on the care that they actually promised now in 2019 the Health and Human Services Inspector General ener found that Medicare Advantage ensures improperly denied payment for care in roughly one out of five claims leaving seniors with piles of unpaid medical bills and just two months last year a giant the giant insurance company siga used a computer algorithm to instantly deny payment for 300,000 claims even though trained doctors are supposed to make those determinations Miss hogland giant Medicare Advantage insurers are overcharging the government they are pedling false promises and then they're turning around and denying care to seniors and people with disabilities so this is why CMS has taken steps to start to crack down on deceptive marketing and unfair denials of care do you think think that the government's proposals go far enough um no I I think there is more opportunity and again that that's why we're here today um one of the things that we specifically have suggested around the marketing tactics that are currently um out there and the the additional payments that we see going to um fmos or or middlemen is to really um require some additional transparency so that it's very clear what all the dollars are and how they're flowing and understanding who might be the the Bad actors um so that those can be addressed specifically and then really thinking about once we understand how the money flows how do we put maximum true maximum caps on some of these items so that they can't continue to be leverage um for um financial gain well I very much appreciate it and very much appreciate your help in in trying to expose these problems today and appreciate the help from all of you you know it's simple resp responsible insurers don't lie and cheat seniors to make a buck but it's clear that the big Medicare Advantage insurers aren't playing by the same set of rules as some of the smaller insurers and I appreciate the steps that CMS has already taken but they need to go further by making the Medicare Advantage ures publish accurate data on patient care and out-of-pocket cost and cracking down on practices like upcoding doing all of this to the full extent of their Authority so thank you all for being with us today and with that uh for the information of the Senators questions for the record will be due by 5:00 pm on October 25th and this hearing is adjourned thank you

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Length: 98min 49sec (5929 seconds)

Published: Wed Oct 18 2023