Medicare Advantage plans sound great, but they are not all they appear. Some benefits are greater than basic Medicare – but not necessarily when Medigap is included. The much touted additional benefits are limited. MA plans do apply co-pays for hospital care and physician and other services beyond those from a primary care physician. All these things vary by plan and if you want to switch to basic Medicare and a Medigap plan, it’s not without limitations.
Most of all in a MA plan you are typically limited in your choice of health care providers. Some health care services are likely subject to pre-approval.
The fact is a Medicare Advantage Plan can work well for some people, maybe even save them money, but the trade off is you are accepting many of the requirements, limitations and oversight of health care that people often complain about with their pre-Medicare health insurance.
Starting next year, insurers will not be able to air any television ads for Medicare Advantage (MA) plans before getting approval from federal regulators.
The new requirement is part of a larger effort by the Centers for Medicare & Medicaid Services (CMS) to address concerns in MA marketing practices. The new effort, announced in a memo released Oct. 19, comes as a Senate panel is also investigating how MA plans reach customers.
“We have reviewed thousands of complaints and hundreds of audio calls and have identified numerous issues with information provided to beneficiaries that is confusing, misleading and/or inaccurate,” the memo to MA plans said.
Currently, MA television ads can be accepted via the agency’s File and Use framework, where an insurer can certify the marketing materials meet agency guidelines. Any marketing material that isn’t designated part of this File and Use framework must get agency approval before distribution.
Starting Jan. 1, 2023, CMS announced that television ads will not qualify for the File and Use framework, meaning they must get approved beforehand. CMS will review all previously submitted TV ads to confirm materials meet the agency’s requirements.
The agency has been worried that national TV ads may confuse beneficiaries about a plan’s potential options.
“CMS is particularly concerned with recent national television advertisements promoting MA plan benefits and cost savings, which may only be available in limited service areas or for limited groups of enrollees, overstate available benefits, as well as use words and imagery that may confuse beneficiaries or cause them to believe the advertisement is coming directly from the government,” the memo said.
Read more at the link below.
Fierce Healthcare
QUINNSCOMMENTARY 
CMS staff does not process claims. It is all contracted out to insurance companies and claims administrators.
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How much will this MA approval impact CMS staff and take away from them processing original Medicare claims in a timely manner?
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