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Rep. Morgan Griffith, R-Va. (Photo: Griffith)

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'Mom' Factor Helps Medicare Advantage Plans at House Hearing

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What You Need to Know

  • About 27 million of the 64 million Americans with Medicare have Medicare Advantage plan coverage.
  • The House Energy and Commerce oversight subcommittee heard criticisms on the program and coverage denials.
  • Many lawmakers started their remarks by acknowledging how popular the program is in their districts.

A House panel held a hearing on the Medicare Advantage program Tuesday — and demonstrated, repeatedly, that the program is very popular with the panel’s members.

The House Energy and Commerce health subcommittee tied the hearing to a recent, hotly contested report on Medicare Advantage plans’ coverage denial procedures. Witnesses talked about program weaknesses.

But many of the lawmakers who expressed concerns acknowledged that many constituents are using the program.

Rep. Morgan Griffith, R-Va., talked about a Medicare Advantage plan enrollee who’s near to his heart: a parent.

“My 92-year-old mother reports to me that she loves her Medicare Advantage plan,” Griffith said, at the hearing, which was streamed online.

A video recording of the hearing is available here.

What It Means

Congressional budget-cutters are looking for ways to cut federal spending and the federal budget deficit, and some see the $350 billion the federal government spends each year on plan enrollees’ coverage as a possible spending reduction target.

Program plans now provide coverage for about 27 million of the 64 million people now on Medicare, and lawmakers’ growing familiarity with the program might make it a difficult place for lawmakers to reduce spending.

The popularity of the program may mean that any clients who have Medicare Advantage plan coverage this year might find that their coverage will stay about the same for at least the next few years.

The Criticisms

Erin Bliss, a witness from the U.S. Department of Health and Human Services Office of Inspector General, repeated the views of that office that Medicare program managers may need to clarify the rules plans follow when deciding whether to cover care.

The Better Medicare Alliance, a group that represents insurers and other parties with an interest in the program, said that the coverage denial rate is low, and typically the result of the complexity and ambiguity of Medicare program rules.

Leslie Gordon, a witness from the U.S. Government Accountability Office, talked about the GAO’s views that a small percentage of plans may have some quality issues, such as issues with access to the kinds of providers that enrollees tend to use in the last year of life.

The Better Medicare Alliance has argued that unclear Medicare hospice coverage rules may be partly to blame, and that the GAO failed to acknowledge that 95.6% of program enrollees told Medicare managers in 2019 that they were satisfied, or very satisfied, with their level of provider access.

Close Contact

Many lawmakers acknowledged that their constituents like the Medicare Advantage program.

Rep. Diana DeGette, D-Colo., the subcommittee chair, said watching the program’s quality is important because of its “tremendous size and growth.”

Griffith noted during the hearing that Medicare Advantage plans can have zero-dollar premiums and often offer important supplemental benefits, such as dental coverage and fitness benefits.

“In 2022, the average Medicare Advantage plan enrollee has access to nearly $2,000 in extra benefits annually that Medicare fee-for-service enrollees cannot access without purchasing additional health insurance coverage,” he said.

Though, he admitted, “my mom’s not taking advantage of any fitness benefits.”

Pictured: Rep. Morgan Griffith, R-Va. (Photo: Griffith)