Twenty-two groups — most healthcare related — signed a letter advocating for a bill that aims for fairer comparison between Medicare Advantage and fee-for-service, according to a Feb. 4 news release from AHIP (formerly America’s Health Insurance Plans).
Reps. Aaron Bean, R-Fl., and Kevin Hern, R-Okla., introduced the bill — known as the Apples to Apples Comparison Act — in June, but it has not passed the House. Under the bill, the Medicare Payment Advisory Commission would analyze average expenditures for MA enrollees and compare them to fee-for-service beneficiaries who are eligible, but not enrolled, in MA. The bill would also have MedPAC account for out-of-pocket expenditure caps, supplemental benefits and benefit integrations for covered part D drugs through MA. Demographic differences and hierarchical condition category risk scores would be other factors to consider.
“The need for sound, data-driven reform has never been greater. Policymakers and the public deserve reliable information to evaluate how the program is performing relative to traditional fee-for-service Medicare,” the Jan. 28 letter said. “Unfortunately, today’s analyses rely on incomplete or inconsistent data, leading to comparisons that do not fully account for differences in eligibility, benefits or value to beneficiaries.”
Signatories representing health plans include AHIP, the BCBS Association, the Special Needs Plan Alliance, the National MLTSS Health Plan Association, Puerto Rico Medicaid and Medicare Advantage Products Association, and the Alliance of Community Health Plans. The U.S. Chamber of Commerce and America’s Physician Groups signed the letter, as well.
“It doesn’t make any sense to use those old fee-for-service numbers as benchmarks or barometers or guides for setting rates or any other sort of policies,” ACHP President and CEO Ceci Connolly told Becker’s, referring to deeper MA penetration across the country. “We have been urging for quite a while that you really need a fresh mathematical system when it comes to Medicare Advantage.”
