US health officials seek new restrictions on private Medicare Advantage plans

The proposed regulations would crack down on misleading advertisements for private plans and strengthen the review of medical coverage denials.

Federal health officials are proposing a comprehensive set of tougher rules governing Medicare Advantage private health plans, in response to widespread complaints that too many patient medical claims have been denied at wrong and that the marketing of the plans is misleading.

Medicare Advantage is the private sector alternative to the federal program covering ages 65 and older and people with disabilities. By next year, more than half of Medicare beneficiaries are expected to be enrolled in private plans. These policies are often less expensive than traditional health insurance and sometimes offer attractive additional benefits like dental care.

Despite their popularity, the plans have made the subject to considerable scrutiny and criticism. lately. A recent report by the Inspector General of the US Department of Health and Human Services found that several plans may be inappropriately denying patient care. And nearly every major insurance company in the program, including UnitedHealth Group, Elevance Health, Kaiser Permanente and Cigna, has been sued by the Justice Department for fraudulent government overbilling.

The run-up to this year's registration deadline, December 7, amplified widespread criticism of deceptive tactics that some brokers and insurers had used to entice people to switch plans. In November, Senate Democrats released a scathing report detailing some of the worst practices, including ads that appeared to depict federal agencies and ubiquitous TV ads featuring celebrities.

Federal health insurance officials have said they will review TV advertising before it airs, and the new rule targets some of the practices identified in the Senate report that caused some consumers to confuse the companies with the government's Medicare program. A proposed settlement would ban plans from using the Medicare logo and require the company behind the ad to be identified. insurers in response to the growing number of complaints about misleading marketing activities,” said Tricia Neuman, executive director of the center for health insurance policy at the Kaiser Family Foundation. Ms. Neuman and her team regularly review TV ads for the plans.

The proposal would also allow recipients to opt out of marketing calls for the plans and limit the number of companies can contact a beneficiary after he has completed an information request form. The Senate report describes patients who received dozens of aggressive marketing calls they did not ask for.

David Lipschutz, associate director at the Center for Medicare Advocacy, said that while the federal government's proposed rules didn't include everything on its wish list, the goals were broad and significant.

"It's really is a meaningful response," he said. "And where we sit, we don't say that often."

Mr. Lipschutz said the changes would ultimately be judged by the effectiveness and aggressiveness of Medicare's enforcement...