The Centers for Medicare & Medicaid Services (CMS) is asking for your help as it seeks to increase the transparency of the privately managed Medicare Advantage (MA) plans and to strengthen the program's data capabilities.
“Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their health care is a black box,” Xavier Becerra, secretary of the Department of Health and Human Services, said in a statement. “The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions. It deprives researchers and doctors of critical data to evaluate problems and trends in patient care.”
To that end, the CMS has issued a request for information (RFI) for the public to give data-related input on all aspects of the Medicare Advantage program.
Comments are due by May 29.
What is and is not working
While traditional Medicare — Parts A and B — covers a large portion of medical expenses after you turn 65, there are things Medicare doesn't cover, as Kiplinger has previously reported. This is where Medicare Advantage, a supplemental plan, can help.
The CMS said the information it gathers from the RFI will be used to strengthen its data capabilities and guide policymaking. The agency needs the data so that it can measure what is and is not working.
"In healthcare, you can't improve what you don't know, and the way to know is with data," said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare.
The types of information requested includes data on access to care, prior authorization, provider directories and networks; supplemental benefits; marketing; care quality and outcomes; value-based care arrangements and equity; and healthy competition in the market, including the effects of vertical integration and how that affects payment.
Transparency is especially important, the CMS said, because Medicare Advantage enrollment has grown to more than 50% of Medicare enrollment. This puts the government on the hook for about $7 trillion in payments to Medicare Advantage health insurance companies during the next decade, it said.
The CMS said that the information solicited by the RFI will support its efforts to:
- Ensure MA plans best meet the needs of people with Medicare.
- Ensure that people with Medicare have timely access to care.
- Ensure that MA plans appropriately use taxpayer funding.
- Ensure that the MA market has healthy competition.
To access the RFI, visit the Federal Register’s webpage and follow the prompts.
