PRESIDENT’S FORUM 138 – Discussion with Senator’s Medical Staff Member

by Jacqueline Robinson

Discussion with Senator’s Medicare Staff Member The NRLN regularly has discussions with Congressional staff members to advise Representatives and Senators on Medicare and Medicare Advantage (MA) issues. Such was the case on September 2 when Alyson Parker, NRLN Executive Director, and I had a conference call with the Medicare policy expert for a chairman of a Senate Committee.

We brought to the attention of the staffer the NRLN’s position that the Centers for Medicare and Medicaid (CMS) should provide on its website a list of the insurers and the premium prices they charge for each Medicare supplemental plan (Medigap) they sell by zip code. This would allow original Medicare beneficiaries and potential original Medicare new enrollees to shop for the best Medigap plan that addresses their healthcare needs and their financial affordability. We explained that providing this information puts more information into the hands of the consumer allowing them to make an informed choice, but also will increase competition between the plans which is a win for seniors.

Moreover, the information is provided to State Health Insurance Assistance Programs (SHIP) that provide objective insurance counseling and assistance to Medicare-eligible individuals, their families, and caregivers, but not all state SHIPS use it. Thus, making one common database available to all would allow a more efficient and reliable one-stop Medigap access.

The Senator’s staff member expressed interest and recommended that the NRLN recruit other retiree organizations to form a coalition to lobby members of Congress to urge CMS to post the insurers and prices for Medigap plans. The NRLN will be working to engage other groups for this effort.

We also noted that having such a database on the Medicare website would have saved Tennessee Valley Authority (TVA) retirees from paying higher priced premiums for their Medigap coverage. In the summer of 2016, TVA announced it was terminating its retiree supplemental healthcare plan coverage, effective in 2017. Before and during a federally mandated Special Enrollment Period (SEP), 14,000 retirees received misleading and insufficient information from a Private Medicare Exchange (PME) firm that dissuaded them from enrolling in lower priced Medigap plans that were available on the open market. Premiums for those Medigap plans have proven to be, in some cases, 38% to 67% higher for females and 35% to 52% higher for males than the same Medigap plans available through local agents or brokers. The NRLN continues to seek an SEP as a remedy.

Also during our conference call discussion, I briefly went over the research that I have been doing on MA plans since the 1990s. I have concluded there are four facts that can’t be denied: 1) healthcare costs are rising four times faster than Medicare enrollees, 2) private plan Medicare market share rose by 2% to 46% (27.4 million enrollees) in 2021; revenue was $350 billion, 3) after 37 years (1985-2022) of dolling out over $450 billion in rebates, the Committee for Medicare and Medicaid Services (CMS) payments per Medicare Advantage (MA) plan enrollee increased to 103% of payments made per enrollee for Medicare Fee-for-Service (FFS) enrollees in 2020 and to 104% in 2022, 4) it’s time to realize that subsidized growth can no longer be justified, Congress, CMS and Insurers must be held accountable!

I emphasized that it is unfair and discriminatory that 24.7 million MA plan participants receive taxpayer subsidized benefits, such as vision, hearing, dental, over the counter drugs, etc. There are also cost-sharing subsidies like paying premiums, deductibles and copays for services like changing home air filters and carpet shampooing that are all denied to the other 39 million original Medicare enrollees.

I shared the NRLN’s proposals:

  • Rely on data from Medicare Trustee, MedPAC, General Accounting Office and Congressional Budget Office reports [to Congress]. (For example: Aggregate Medicare payments to MA plans have never been lower than original Medicare’s Fee-for-Service spending. The current state of MA quality reporting is such that the can no longer provide an accurate description of the quality of care in MA.)
  • Grandfather benefits for current MA Plan enrollees or grant MA enhanced benefits to all in Medicare. — Use Quality Control and Innovation to reduce FFS costs.
  • Eliminate the Capitation Model – focus on setting more relevant FFS Benchmarks and require all risk adjustments and expected payments be actuarily assumed in bidder pricing vs benchmarks.
  •  Eliminate QBP Bonuses and Rebates and FFS competitive barriers; create a Level Playing Field. Recently, CMS issued a Request for Information (RFI) on MA.

To read the document the NRLN submitted go to:

Bill Kadereit, President
National Retiree Legislative Network

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