Marketing Complaints May Hurt Medicare Plan Grades More in 2023

What You Need to Know

  • Star ratings affect how much cash Medicare plans get from CMS.
  • CMS already has one measure for consumer complaints about plan marketing in the plan star ratings, and it wants to add a second measure, for complaints that could lead to retrospective disenrollments.
  • Many traditional, brick-and-mortar agents have expressed concerns about some of the big, national Medicare plan marketing campaigns.

Managers of the Medicare Advantage and Medicare Part D prescription programs want to hit the plan issuers’ “star rating” grades harder when consumers say plan marketers lied to them.

The Centers for Medicare and Medicaid Services has adding a second measure for Medicare Advantage marketing problems to the plans’ star ratings.

CMS officials say they tried applying the proposed measure to a batch of plan star ratings for 2021 coverage and found that the measure would have cut 24% of the star ratings for Medicare Advantage plans that offer prescription drug coverage.

In theory, the proposal could hit insurers with a large number of consumer complaints about hard marketing, because CMS pays plans with high star ratings more, and consumers may be more likely to choose plans with high star ratings.

CMS included the Medicare plan grade marketing penalty proposal in a short section in an advance notice that describes how Medicare plan programs might work in 2023.

The Centers for Medicare & Medicaid Services is predicting in the new 2023 Advance Notice packet for the programs that issuers’ 2023 base level of federal support will increase by 4.75%, and that their average total revenue will increase by an average of 7.98%.

Mary Beth Donahue, president of the Better Medicare Alliance, a group that represents insurers and other groups and individuals that support the Medicare Advantage program, said in a comment on the advance notice that the alliance sees the document as a “thoughtful proposal.”

The proposal “will help ensure stability for the millions of diverse seniors and individuals with disabilities who count on Medicare Advantage,” Donahue said.

Medicare Plan Background

The Medicare Advantage program gives insurers a chance to sell health plans that look to the assured like an alternative to traditional Medicare coverage.

The Part D prescription drug plan program lets insurers sell subsidized drug coverage to Medicare program enrollees.

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