The 'wild west' of Medicare Advantage, and how to fix it

The average older adult has dozens of Medicare Advantage plans to choose from, and many turn to brokers to help them make a decision about the best option for them. 

Insurers pay commission to brokers enrolling new and returning members in their plans, but in a competitive market, these commissions are climbing too high, Michael Bagel, associate vice president for public policy at the Alliance of Community Health Plans, told Becker's. 

In September, ACHP sent a letter to congressional leaders, urging them to ask CMS to implement tougher standards on limiting maximum payments to brokers. 

In 2009, CMS established maximum amounts health plans can pay brokers — $611 for a new enrollee and $306 for returning enrollees in 2023 — but there are no limits on add-on fees. 

"What we've seen now, especially in recent years, is that there is such competition for many consumers that brokers are asking for additional fees, additional compensation on top of their commission. These fees can, in certain cases, more than double what the maximum commission was," Mr. Bagel told Becker's. 

Broker fees ultimately come from Medicare trust dollars, Mr. Bagel said, so plans have to balance broker compensation with benefits and costs for consumers. 

"As health plans who are stewards of the taxpayer dollar and the Medicare dollar, we should put limitations on the total amount we're able to compensate brokers, so it's not the wild west out there, not the arms race of who can pay the most. That's not the goal. We want the broker to help the consumer select the best health plan for them, not the one that they can receive the most money from," Mr. Bagel said. 

Curbing broker payments is one part of ACHP's MA for Tomorrow initiative, a five-pillar proposal aimed at improving quality in the program and improving consumer experience. 

Another facet of the initiative is reining in misleading Medicare Advantage marketing. Thousands of Medicare Advantage advertisements hit the airwaves each day during the open enrollment period from Oct. 15 to Dec. 7, though CMS has implemented new rules that require plans to have television advertising approved by the agency and bars advertisements that do not mention a specific plan. 

Mr. Bagel said the tougher marketing standards are a "great step in the right direction" for protecting consumers. 

"We are very excited about the prospect and look forward to making sure that we tamp down on things that can confuse consumers, and frankly that are deceptive. We should have aggressive competition for consumers, and leverage the marketplace of good ideas and all products to make them available to them. But what we don't want to have are confused consumers, or those who feel duped or pushed into one product or another," he said.

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