CMS giving big, erroneous plug to Medicare Advantage in handbook draft?

• CMS’ 2019 Medicare & You handbook appears to give Medicare Advantage an extra plug, judging by changes in a draft version of next year’s manual, Axios reports.
• Compared with this year’s handbook, the draft replaces a section on “quality of care” with one on “coverage and cost determinations” — suggesting that cost-conscious beneficiaries might want to shop for MA plans.
• The revised version also devotes a page to promoting Medicare Advantage open enrollment, a provision in the 21st Century Cures Act that allows people to try out a plan for three months before committing to it.

Also, the draft adds a section explaining that people in MA plans “have the right to request a preauthorization” for healthcare services or equipment, encouraging people to use this tactic when choosing providers.

That may win kudos from insurers, which have been flocking to the MA market, but pointing out such policies as a way to get people to shop around is likely to get pushback from providers.

The draft handbook also includes what could be misleading information on private contracting, which lets Medicare patients and providers who opt out of Medicare sign private contracts for services. A new sentence reads: “Private contracts give you and your provider the flexibility to set up your own payment terms that work best for you.” What is left out is that people who sign private contracts could face higher fees or surprise billing.

In a letter to CMS Administrator Seema Verma, three consumer groups — the Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center — criticized the draft, saying suggestions that Medicare Advantage is the less expensive alternative for beneficiaries are overstated and the draft doesn’t clarify the difference between traditional Medicare and Medicare Advantage.

“Even more problematic is the treatment of prior authorization in Medicare Advantage,” the groups write.  The draft “attempts to paint this restriction on access to services as a benefit, rather than what it is, a mandatory hurdle for Medicare Advantage members that is not required for individuals in Original Medicare.”

Payers like MA, which they see as a stable market. The average premium for MA plans was expected to be about 6% lower this year than last year, and CMS predicted 77% of MA enrollees would stay in their current plan. The typical enrollee is someone who once had employer-based healthcare, so is mostly familiar with insurance policies and isn’t likely to have untended healthcare needs.

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