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Senators Urge for More Regulations on 'Unscrupulous' Medicare Advantage Marketing

Analysis  |  By Jay Asser  
   November 18, 2022

In a letter to CMS, lawmakers highlight five steps they want the agency to take to counter deceptive practices.

U.S. senators have asked CMS to take action to protect beneficiaries from harmful Medicare Advantage (MA) marketing tactics through further oversight and regulations.

Thirteen senators penned a letter to the agency outlining five changes CMS can make through notice and comment rulemaking and sub-regulatory guidance as soon as possible.

The letter comes after the Senate Finance Committee's investigation into MA marketing practices, which found a "concerning pattern of misleading advertising materials, aggressive marketing tactics, and in some cases flat-out deception harmful to beneficiary access to care and health outcomes," the senators wrote.

Complaints over MA marketing are not new, with the letter pointing to when Congress addressed abuses in 2008 and CMS issued civil monetary penalties to MA plans. However, the senators state that the Trump administration weakened protections and found workarounds to take advantage of beneficiaries.

The letter commends CMS for implementing the changes it already has, which includes a new policy, effective January 1, 2023, which would require CMS approval before running television advertisements for MA or Part D prescription drug plans.

The following five steps would strengthen protections further, the senators argue:

  1. Reinstate requirements loosened during the Trump administration: This includes banning educational and marketing events from occurring on the same day at the same location.
  2. Monitor MA disenrollment patterns and use enforcement authority to hold bad actors accountable.
  3. Provide clear guidelines and trainings to ensure agents and brokers understand and adhere to best practices: Agents and brokers should be accountable
  4. Implement robust rules around MA marketing materials and close regulatory loopholes that allow cold-calling.
  5. Support unbiased sources of information beneficiaries, including State Health Insurance Assistance Programs and the Senior Medicine Patrol.

"We share the same goal to enable the offering of MA plan choices that are valuable to seniors and people living with disabilities," the senators wrote. "Yet, our first responsibility is to protect beneficiaries and the integrity of the MA program from fraudsters and scam artists who look to take advantage of any opportunity to prioritize profits over beneficiary health and well-being."

Jay Asser is the contributing editor for strategy at HealthLeaders. 

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