Trump Looks Past Medicare Advantage Audit Errors

By: Lewis Mark
Published: Thursday, December 27 2018
Last Updated: 8 months ago

There's news of Trump pushing Medicare Advantage plans and giving them more control. The administration doesn't want to punish Medicare for errors in doctor directories. This further proves that the Centers for Medicare and Medicaid Services is leaning towards alternative options over the traditional Medicare programs.

Earlier this month, an audit was released on the official CMS website. The CMS found that half of these healthcare plans contained one error in the doctor directories that helps patients find a health care provider in their area. Most of those directories had incorrect information such as the wrong phone number or address. Some of the listings indicated that a doctor was taking new patients even though that doctor wasn't.

This Isn't The First Time

This isn't the first findings from CMS. It's the third time CMS has found errors in the doctor directories. In 2017, the agency threatened to fine healthcare plans if they didn't fix their doctor directories. While this year's report doesn't show any improvement from last year, or the year prior, CMS hasn't followed through on their threats. Most of those warnings are looking like empty threats at this point.

Medicare Advantage is a healthcare program through the federal government that pays private health insurance companies to cover seniors instead of sending direct payments to doctors and hospitals. It's the traditional form of Medicare. It has become increasingly popular among seniors since it covers services like doctor's visits, dental care, vision, and prescription drugs. Over one-third of seniors are expected to be on some form of these plans by 2019.

It's not just favored by seniors, Republicans love the program as well. It promotes healthy competition among health insurance companies and adds seniors to managed care programs, which promote better health outcomes. The average premiums are reported to decline to 6% by next year. Democrats want to cut funding from Medicare Advantage plans and use the money to help pay for the Affordable Care Act.

The reason for its popularity is due to its wide variety of options for seniors. They have more control when it comes to their coverage needs. Seniors can choose a plan that best fits their healthcare needs as well as their budget. It's been reported that over 22.6 million beneficiaries will sign up for Medicare Advantage plans by the year 2019. This is a projected growth of 11.5%.

Seniors don't realize they have control of these plans. It's important to remind them that if they don't like their current plan, they have the freedom to choose another that provides great flexibilities. They have plenty of options when it comes to finding a plan that meets their needs. These new tools will increase just as long as beneficiaries want them. Seniors like having control and saving money, which are two big factors with these plans.

Some Medicare beneficiaries have noticed a different tone in their emails from CMS asking them to re-enroll for the next year. The emails praise these plans while providing little information about traditional Medicare, which covers 35 million Americans. Most of these emails have urged beneficiaries to switch to these plans to help them save money. Some have claimed these emails sound more like an advertisement for Medicare Advantage rather than information about traditional Medicare.

One disadvantage to private health plans is that members have to verify their doctor is within their plan's network. That relays back to the issue with errors in the doctor directories. This has become a massive problem for private insurance plans that the CMS doesn't want to fine at the moment. Errors are a problem for those who choose a health insurance plan because its network works with their doctor or specialist.

A directory that's out-of-date or riddled with errors can lead to problems and confusion. Health insurance plans can't just correct these directories. Since 20 to 25% of providers move offices each year, it's hard for health care plans to keep up with the changes. Most plans are expecting to see fines for their doctor directories even though CMS hasn't followed through with their threats. The Obama administration began looking into this issue, but there's been little progress with the Trump administration.

The Trump administration is focused on writing Act Two to address the country's rising costs of prescription drugs. Their next move could impact both the drug industry and the Medicare program. When Trump visited the Department of Health and Human Services, he said that Medicare will pay for most prescription drugs. Those changes are limited and can only be applied to prescription drugs administered by a doctor who's on the Part B program. The Trump administration wants to test it out in the next five years to half of the country.

Trump and HHS Secretary Alex Azar said they're both willing to make these changes. They want to go further than most Republicans have in regards to the issue with rising drug prices. They don't care if the pharmaceutical industry will be impacted by it. The administration will continue to focus on this Medicare issue for now.