Associations Urge Stronger Oversight of MA Marketing Practices

In a letter to CMS, NPA and LeadingAge detail concerns about MA plans marketing supplemental benefits without appropriate safeguards.

WASHINGTON, DC – Aug. 7, 2024 – Citing the negative impact that aggressive and misleading marketing practices of Medicare Advantage (MA) plans have on older adults served in Programs of All-Inclusive Care for the Elderly (PACE) programs, two national associations representing PACE organizations urged the Centers for Medicare & Medicaid Services (CMS) to strengthen oversight to protect beneficiaries from harm.

In a July 25 letter to CMS administrator Chiquita Brooks-LaSure, the National PACE Association (NPA), the national association representing all current PACE organizations, and LeadingAge, the national association of nonprofit and mission-driven providers of aging services, including PACE, explained how the marketing of cash supplements, in the form of debit cards, by MA plans is misleading older adults and disrupting their access to needed services provided to them by PACE organizations.

“We share CMS’ stated desire that people have access to accurate and complete information when they make health care choices,” said Shawn Bloom, president and CEO of NPA. “We have numerous examples of vulnerable seniors being induced to enroll in MA plans without being fully informed of what they are giving up when they enroll.”

“The financial and health implications of uninformed disenrollment from PACE to conventional MA plans are significant,” added Katie Smith Sloan, president and CEO of LeadingAge. “The needs of PACE beneficiaries, most of whom have multiple complex medical conditions, cognitive or functional impairments – or all three – are not comprehensively addressed by MA plans. The loss of PACE services is harmful and, in some cases, can be life-threatening.” 

The marketing practices not only distort healthy competition among Medicare beneficiaries’ coverage options but, more importantly, pose significant and potentially dire health risks for affected enrollees when considering access, cost and coverage differences between and among plans.

Stronger enrollee protections are needed to ensure that beneficiaries have accurate and appropriate information to make a fully informed decision prior to enrolling in an MA plan, the letter stated. This is especially critical for PACE participants for whom disenrollment from their integrated PACE plan likely would result in increased out-of-pocket costs and far less comprehensive coverage.

The letter called on CMS to implement a series of changes:

• require MA plans to explain all out-of-pocket costs and network/coverage limitations clearly and fully, based on standardized language, to prospective enrollees prior to their enrollment in an MA plan;
• stipulate additional measures during the PACE participant voluntary disenrollment process (42 CFR § 460.162), e.g., requiring written revocation of PACE coverage analogous to the Medicare hospice benefit, to ensure the authenticity and intentionality of the participant’s voluntary disenrollment;
• permit mid-month enrollment in PACE for former PACE participants to re-enroll in PACE if beneficiaries want to return to PACE following their disenrollment from an MA plan; and 
• clarify that when MA brokers inform beneficiaries of the comparative benefits of their current coverage (e.g., PACE) to an alternate MA plan, they must inform them in plain language if they would be enrolling in a plan that does not cover or coordinate their Medicaid benefits and any benefits the individual would lose under the new plan (e.g., transportation to buy groceries).
  

The National PACE Association (NPA) works to advance the efforts of PACE programs, which coordinate and provide preventive, primary, acute and long-term care services so older individuals can continue living in the community. NPA represents all 177 PACE organizations that operate in 33 states and the District of Columbia, serving more than 78,000  participants across the country. For more information, visit www.NPAonline.org and follow @TweetNPA.

LeadingAge represents more than 5,400 nonprofit aging services providers and other mission-driven organizations serving older adults that touch millions of lives every day. Alongside our members and 36 partners in 41 states, we use advocacy, education, applied research and community-building to make America a better place to grow old. Membership encompasses the entire continuum of aging services, including skilled nursing, assisted living, memory care, affordable housing, retirement communities, adult day programs, community-based services, hospice and home-based care. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information, visit leadingage.org