Inaccuracies and Bias in Draft MEDICARE & YOU Handbook
The Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the draft 2019 Medicare & You Handbook, and urged CMS to rectify the errors prior to dissemination.
As stated in a joint press release about the letter, without fair and accurate information, older adults, people with disabilities and their families cannot make informed choices about their Medicare and health care coverage. The organizations assert that rather than presenting information in an objective and unbiased way, the draft Handbook’s information about traditional Medicare and Medicare Advantage (MA) distorts and mischaracterizes facts in serious ways. For example, the draft Handbook:
- Suggests that MA is the less expensive alternative for beneficiaries;
- Fails to highlight the clear distinction between traditional Medicare and MA: Traditional Medicare provides access to all Medicare participating providers nationwide, while MA limits access to a set network of providers in a specific geographic area; and
- Characterizes prior authorization requirements in MA plans, which are restrictions on access to services, as a benefit, rather than as what they are: Mandatory hurdles for MA members not required for individuals in traditional Medicare.
When counseling Medicare beneficiaries about their coverage options within the Medicare program, it is common to point out both the pros and cons of different choices, including the difference between traditional Medicare and MA. The language in the draft Handbook, following a recent trend (as discussed below), over-emphasizes the benefits of enrolling in an MA plan and minimizes the drawbacks, leaving readers with a misleading overview of the MA program.
Recognizing the importance of the government presenting information about Medicare in an accurate and unbiased manner, a number of media outlets wrote about the groups’ concerns. For example, Phil Moeller from PBS stated that the draft Handbook “creates the impression that MA plans are less costly to seniors than original Medicare. This may or may not be true; it depends on the types of coverage selected and a beneficiary’s individual medical needs.” Further, as noted by Bob Herman of AXIOS, “[h]ealth insurers and doctors wouldn't mind these changes because they could make their plans and practices sound more appealing to Medicare enrollees — potentially boosting their income.”
Recent Pattern of Government Favoring MA Enrollment
As noted in an October 2017 CMA Alert, the Center wrote that official CMS Medicare Open Enrollment materials for 2018 – issued in Fall 2017 – tipped the scales to encourage beneficiaries to choose a private Medicare Advantage plan over original Medicare.
On November 9, 2017, the Leadership Council of Aging Organizations (LCAO), a member coalition of the nation’s non-profit organizations serving older Americans, sent a letter about this issue to CMS and committees of jurisdiction in Congress.
The organizations listed in the letter wrote to express concerns that during the last Medicare open election period, CMS encouraged entities that assist Medicare beneficiaries with enrollment choices to disseminate information that was incomplete, biased towards Medicare Advantage (MA) and often failed to even mention traditional Medicare. The organizations urged CMS to take immediate corrective action to include and accurately portray the benefits and drawbacks of all coverage options in CMS materials.
Instead of heeding such concerns, CMS has made such bias towards MA even more pronounced in the draft Medicare & You Handbook.
Such efforts to steer Medicare beneficiaries towards enrollment in MA plans is part of a larger pattern among policymakers and administrators to favor the MA program over traditional Medicare. As the Center noted in a March 2018 CMA Alert, recent changes in law, regulation and sub-regulatory guidance combine to more broadly tip the scales in favor of Medicare Advantage v. traditional Medicare.
In an article discussing the draft Medicare & You Handbook, Reuters journalist Mark Miller stated:
the handbook problems fit a pattern in the Trump administration, which has taken a number of steps to impede the flow of unbiased health insurance assistance. The administration has twice proposed to eliminate federal funding for State Health Insurance Assistance Programs, which provide critical assistance to 3 million seniors annually with their plan selections, and it has slashed funding for consumer outreach and enrollment assistance for Affordable Care Act coverage.
In our press release relating to the letter the Center, Justice in Aging and the Medicare Rights Center sent to CMS, we stated:
Medicare & You is the official government publication designed to provide beneficiaries with factual information about the Medicare program, their choices for obtaining coverage, and the benefits they can expect. Unfortunately, the draft 2019 Handbook includes inaccurate descriptions of the differences between original Medicare and private Medicare Advantage plans. Without fair and accurate information, older adults, people with disabilities and their families cannot make informed choices about their health care coverage.
The Medicare statute obligates the Secretary of Health and Human Services, and, by extension, CMS, to provide and promote accurate information about the Medicare program. For example, 42 U.S. Code §1395w-21(d)(1) states: “The Secretary shall provide for activities under this subsection to broadly disseminate information to Medicare beneficiaries (and prospective Medicare beneficiaries) on the coverage options provided under this section in order to promote an active, informed selection among such options. [Emphasis added.]
Recent materials issued by CMS do not meet this criteria. As journalist Miller notes, “[t]here is still time for Medicare to correct the problems – and CMS should play this straight. Medicare Advantage is doing just fine without using the handbook to tip the scales.” Given what is at stake for Medicare beneficiaries and the Medicare program, we urge CMS to heed this advice.
May 31, 2018 – D. Lipschutz
 See, e.g., the Center’s website at: http://www.medicareadvocacy.org/choosing-between-traditional-medicare-and-a-medicare-advantage-plan/; also see the following Weekly Alerts – http://www.medicareadvocacy.org/10-questions-to-ask-before-deciding-between-traditional-medicare-and-a-medicare-advantage-plan/; and http://www.medicareadvocacy.org/what-would-work-better-for-you-deciding-between-traditional-medicare-and-a-medicare-advantage-plan/.
 See, e.g., Inside Health Policy, “Beneficiary Advocates Concerned Medicare Handbook Distorts Program In Favor Of MA” by Michelle M. Stein (5/18/18); BNA's Health Care Daily Report, “Medicare Advocates: Handbook Slanted Toward Managed Care” by Mindy Yochelson (5/21/18) and BNA Health Care Blog, “Shining Some Light on Traditional Medicare” by Mindy Yochelson (5/22/18), available at: https://www.bna.com/shining-light-traditional-b57982092796/; FierceHealthcare, “Advocacy groups blast CMS for incorrectly promoting MA plans, misleading beneficiaries” by Mike Stankiewicz (5/21/18), available at: https://www.fiercehealthcare.com/payer/cms-incorrectly-promoting-ma-plans-lying-to-beneficiaries-groups; AXIOS, “Subtle but consequential changes to Medicare's handbook” by Bob Herman (5/24/18), available at: https://www.axios.com/medicare-subtle-but-consequential-changes-to-handbook-1527102518-fd36b6da-af8b-4315-97b3-1160140bf1e1.html; Reuters, “Ideology threatens to trump facts in official Medicare handbook” by Mark Miller (5/24/18), available at: https://www.reuters.com/article/us-column-miller-medicare/ideology-threatens-to-trump-facts-in-official-medicare-handbook-idUSKCN1IP2Z9; PBS, “Senior advocates say new draft guide to Medicare distorts facts. Here’s what you need to know” by Phil Moeller (5/25/18), available at: https://www.pbs.org/newshour/economy/making-sense/senior-advocates-say-new-draft-guide-to-medicare-distorts-facts-heres-what-you-need-to-know; and Healthcare Dive, “CMS plugs Medicare Advantage in beneficiary handbook draft” by Meg Bryant (5/25/18), available at: https://www.healthcaredive.com/news/cms-plugs-medicare-advantage-in-beneficiary-handbook-draft/524349/.
 PBS, “Senior advocates say new draft guide to Medicare distorts facts. Here’s what you need to know” by Phil Moeller (5/25/18), available at: https://www.pbs.org/newshour/economy/making-sense/senior-advocates-say-new-draft-guide-to-medicare-distorts-facts-heres-what-you-need-to-know.
AXIOS, “Subtle but consequential changes to Medicare's handbook” by Bob Herman (5/24/18), available at: https://www.axios.com/medicare-subtle-but-consequential-changes-to-handbook-1527102518-fd36b6da-af8b-4315-97b3-1160140bf1e1.html.
 Reuters, “Ideology threatens to trump facts in official Medicare handbook” by Mark Miller (5/24/18), available at: https://www.reuters.com/article/us-column-miller-medicare/ideology-threatens-to-trump-facts-in-official-medicare-handbook-idUSKCN1IP2Z9.