Medicare Advantage brokers may face tougher restrictions from the Centers for Medicare and Medicaid after a highly critical Senate Finance Committee hearing Wednesday.
The hearing, the topic of which was "cracking down on deceptive practices," cataloged a litany of alleged abuses by brokers—from providing false information and harassment to switching people out of plans without consent, all in a bid to boost increasingly opaque compensation from insurers. That includes "add-on" fees for administration.
The session came at the start of open enrollment for Medicare and as CMS may update rules that took effect this year to address deceptive brokerage practices, including by blocking misleading television ads. More than 300 ads have been blocked by CMS this year, according to Finance Committee Chair Sen. Ron Wyden (D-Ore.)
The practices attracted criticism from both sides of the political aisle, which was encouraging to Ceci Connolly, the president and CEO of the Alliance of Community Health Plans. She noted that a report last year by the Finance Committee included a number of recommendations for CMS—some of which were adopted, such as the ban on misleading ads.
"I think that the interest shown by Congress will certainly impact the thinking at CMS," Connolly said after the hearing. "That's our hope. That's our expectation based on what they did last year on marketing practices."
Connolly's group represents smaller, regional providers of Medicare Advantage plans. The hearing mostly targeted the practices of brokers who focus on signing people up for the large insurers who control the bulk of the market. UnitedHealthcare and Humana have nearly half of Medicare Advantage members enrolled in their plans, according to a KFF report.
The Finance Committee report last year arrived in November. Wyden said Wednesday that his committee was doing further investigations, but he said what the committee already has demonstrated should be of interest to regulators and the public, since the profits brokers make come from Medicare and taxpayers.
"Insurance experts have told us that marketing cost taxpayers $6 billion in 2022 alone. Put your arms around that," Wyden said during the hearing. "Six billion taxpayer dollars went to marketing middlemen who may have sold your elderly parents, your grandparents, or your neighbors the wrong plan."
In addition to the steps CMS took for this year, Connolly and the committee want the agency to take action in other key areas. They want it to target bad actors who have repeated complaints lodged against them, including by linking those complaints to specific agents who have unique identifiers in the CMS system. They also seek to have broker compensation more aligned with the interests of beneficiaries, as law requires, so a broker focuses less on volume rewards and more on enrolling people into the right plans. And they want better enforcement against brokers who harass people with repeated calls and other contacts.
"We can promote a vibrant and competitive broker landscape, assisting seniors while preventing deceptive marketing and other problematic practices," said Sen. Mike Crapo (R-Idaho).
A statement released after the hearing by the National Association of Benefits and Insurance Professionals suggested the current rules are somewhat onerous, and that agents work diligently to help people. From its perspective, smaller Medicare Advantage providers are seeking an edge through new rules.
“Medicare agents often obtain clients through referrals, which is a type of lead that can only be achieved by providing great service to a beneficiary. By taking the time to understand the unique requirements and preferences of each beneficiary, agents offer tailored solution," said the statement from association CEO Jessica Brooks-Woods.