State Regulators Defend Medicare Supplement Sellers Against Sen. Warren

News April 10, 2023 at 02:22 PM
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State insurance regulators say Sen. Elizabeth Warren, D-Mass., should spend more time monitoring marketing concerns in the Medicare Advantage plan market and less time worrying about incentive travel for top Medicare supplement insurance agents.

The senator recently sent the National Association of Insurance Commissioners (NAIC) a report suggesting that offers of trips to places like San Diego, Hawaii and the U.S. Virgin Islands could lead agents to steer clients toward overly expensive or otherwise unsuitable Medicare supplement insurance policies, or to buy additional, potentially unsuitable supplemental insurance products.

Chlora Lindley-Myers, the NAIC's president, and three other NAIC officers told Warren they see few complaints about the sales and marketing efforts for Medicare supplement insurance policies, which are regulated by the states, and many complaints about sales and marketing efforts for Medicare Advantage plans, which are regulated by the federal government's Centers for Medicare and Medicaid Services.

"The NAIC continues to urge Congress to return [Medicare Advantage] marketing oversight authority to the states," the NAIC officers said.

What It Means

Warren and state regulators have very different ideas about the people and organizations selling private Medicare coverage to your clients.

Private Medicare Plan Basics

Medicare supplement insurance policies are private insurance policies that fill in the many holes in "original Medicare" coverage for about 14 million of the 65 million Medicare enrollees.

Issuers of the policies, which are sometimes called "Medigap" or "MedSupp" policies, use a standardized plan framework developed in 1990.

Between 2017 and 2021, the share of original Medicare enrollees who bought Medigap coverage increased to 41%, from 35%, according to America's Health Insurance Plans.

Medicare Advantage plan issuers provide what looks to enrollees like a comprehensive alternative to original Medicare coverage for about 30 million people.

Medicare Advantage plan issuers typically use managed care strategies, such as funneling large numbers of patients to doctors and hospitals in designated provider networks and taking active steps to coordinate care, to hold down the cost of care. The issuers often use some or all of the savings from care management to provide extra benefits, such as coverage for dental care and hearing aids.

The Better Medicare Alliance, a group for Medicare Advantage issuers and other Medicare Advantage program supporters, including plan enrollees, makes the case that the extra benefits and care coordination are improving the quality of care typical enrollees get, by, for example, increasing the odds that enrollees with diabetes will get appropriate care.

The NAIC and Warren's Letter

Warren could have a significant effect on Medicare.

The Democrats hold a majority in and the Senate, and Warren is a member of three Senate panels that help oversee Medicare: the Senate Special Committee on Aging; the Senate Committee on Banking, Housing and Urban Affairs insurance subcommittee; and the Senate Committee on Finance health care subcommittee.

The NAIC responded to Warren's concerns by asking states about consumers complaints about Medigap sales and marketing efforts.

"A significant majority of responding states reported no such complaints," Lindley-Myers and her colleagues wrote. "One or two states have seen violations of state incentives rules and have taken appropriate action."

When the NAIC updated its Medigap model rules in 2016, it discussed marketing, but no state regulators or consumer advocates suggested the need to change the marketing provisions in the model rules, the NAIC officers said.

Pictured: NAIC President Chlora Lindley-Myers (Credit: Missouri Department of Insurance)

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