The Medicare Advantage business is facing major challenges — government scrutiny is rising, CMS regulations and payments are tightening, the cost of care is rising and negative media coverage abounds.
In response, the health insurance industry is planning "a seven-figure lobbying blitz" in Washington D.C. to fight mounting headwinds and offer a more optimistic view of the benefits MA plans can provide to older adults.
“We're going to be doing everything we can to make sure that policymakers across the political spectrum can be introduced to these seniors and hear their stories and learn firsthand how passionately Medicare Advantage beneficiaries feel about their coverage,” insurance industry trade group AHIP and its CEO, Mike Tuffin, told Politico on Aug. 13.
Through digital and social media ads, along with encouraging seniors to advocate for MA to lawmakers, insurers are looking to convey the message that MA plans provide better and cheaper health coverage than traditional Medicare.
"Seniors have been promised by elected officials in both parties that their Medicare coverage and care would not be cut," Mr. Tuffin told the outlet. "And so our advertising is about reminding elected officials that this is a big constituency that really likes their Medicare Advantage coverage and expects that promise to be kept."
The timing of the campaign comes ahead of the Medicare annual enrollment period, which begins Oct. 15.
The lobbying campaign is not a new strategy for the industry, which most recently aired a Super Bowl ad in February with a simple message for lawmakers: "Don't cut Medicare Advantage."
The 30-second ad references some of the major challenges the MA market has faced this year, including reduced benchmark payments from CMS. CVS Health, Humana and Centene have said they will exit some markets in 2025 — and potentially reduce benefit offerings — to accommodate the changing reimbursement environment and rising costs.
On the media front, national outlets have reported for years that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates. Upcoding reentered the spotlight in July, when the Wall Street Journal began publishing new investigative reports on the issue.
In October 2023, the Department of Justice brought criminal charges against a former MA executive at Elevance Health-owned HealthSun Health Plans, alleging she orchestrated a scheme to submit false and fraudulent information to CMS.
"You have a lot of different things coming together that are drawing unwanted attention to Medicare Advantage and creating a lot of enforcement and oversight," John Kelly, attorney and chair of Barnes & Thornburg's healthcare department and industry practice, previously told Becker's.
In the short-term, MA payers such as CVS are warning that senior care costs could continue to rise in the second half of 2024, with the company noting elevated inpatient, dental and pharmacy claims in the second quarter.