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Medicare Advantage Plan Data Remains Inadequate

Significant gaps in data about Medicare Advantage (MA) plan processes and enrollee experiences make it impossible for policymakers to hold plans accountable and for beneficiaries to make informed coverage choices. This opacity has long been concerning but calls for transparency have taken on a new urgency as MA enrollment and costs escalate.

The number of MA plan members has surged in the last decade, with over half of all eligible beneficiaries now enrolled in MA. Medicare payments to MA plans are also climbing. As a portion of total Medicare dollars, they jumped from 26% in 2010 to 45% in 2020, and may reach 54% by 2030. Per person, Medicare spending is higher and growing faster for MA beneficiaries than for those with Original Medicare (OM). This may cost Medicare $183 billion in the coming years. In 2023 alone, Medicare will pay MA plans about 6% more than OM for similar enrollees, translating to an extra $27 billion.

Unless these imbalances are corrected, MA enrollment growth will continue to increase Medicare spending and lead to inappropriate plan overpayments, raising Part B premiums for everyone and worsening Medicare solvency challenges. These trajectories are additionally concerning because data gaps make it unclear what MA enrollees and taxpayers are getting in return.

A new KFF brief examines several of these transparency issues, highlighting areas where the Centers for Medicare & Medicaid Services (CMS) has the authority to require additional MA plan reporting or to make existing data collections public.  Each information point would improve program transparency and help guide reforms. In the coming weeks, Medicare Rights will explore these topics in more depth.

Unreported Data: What MA Plans Do Not Report to CMS

  • Use of and spending on supplemental benefits, such as dental, vision, and hearing, overall or by enrollee characteristics.
  • Prior authorization requests, denials, and appeals by type of service, enrollee characteristics, or for specific plans.
  • The reasons for prior authorization denials.
  • How long prior authorization decisions take.
  • Share of MA claims that are denied after services have been delivered.
  • Benefit and cost sharing information for employer/union sponsored plans.

Unpublished Data: What CMS Collects but Does Not Publish

  • Out-of-pocket liability and other payment information for MA plans.
  • The names of employers/unions that receive Medicare payments to provide MA group plans to retirees.
  • Characteristics of people who disenroll from MA.

Without this reporting, we cannot know how well MA is working for people with Medicare, including those from underserved communities. This, in turn, prevents beneficiaries from making fully informed enrollment choices and overseers from holding MA plans responsible for their spending, promises, and behaviors. Medicare Rights continues to urge policymakers to address this without delay. MA plans must be subject to enhanced data collection, reporting, and oversight requirements, and CMS must have the resources it needs for enforcement and public reporting.

Read the KFF brief, Gaps in Medicare Advantage Data Limit Transparency in Plan Performance for Policymakers and Beneficiaries.

Read more about increases in MA enrollment.

Policy Issues: Medicare Advantage
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