Medicare Rights Urges CMS to Center Beneficiary Needs in MA and Part D

This week, Medicare Rights submitted comments in response to the annual Medicare Advantage (MA) and Part D proposed rule for 2027 from the Centers for Medicare & Medicaid Services (CMS). The proposed rule has a few positive ideas but reverses course in several important domains. If finalized, those changes would allow more aggressive and misleading marketing while eliminating requirements for plans, agents, and brokers to share important information with beneficiaries and the public.

The Positives

Better Public Access to Risk Adjustment Data

One of the bright spots in the proposed rule would help the public gain access to data on risk adjustment, one factor that affects the way plans are paid. We support this proposal, as it could improve research and oversight as well as help combat overpayment.

Help for MA Enrollees When Providers Leave Plans

Another potential policy would streamline beneficiary access to a Special Enrollment Period (SEP) when their providers are no longer in network for a plan. We support the outlined change, as it would help people switch plans to keep seeing their chosen providers, promoting care continuity and beneficiary choice.

Allowing Enrollees in Integrated D-SNPs to Keep Their Coverage

The proposed rule would relax a forthcoming requirement that would have pushed Dual Eligible Special Needs Plans (D-SNP) enrollees in some states, including New York, away from plans that do more to integrate Medicare and Medicaid coverage. We support this proposal, though we continue to urge CMS to help states and plans truly integrate coverage for people who are dually eligible.

A separate proposal would change rules about when some D-SNP enrollees can be automatically enrolled in other plans. While enrollees would be able to undo such changes, these types of passive enrollments can often lead to people losing access to their chosen providers or being very confused about their coverage. We oppose this and other proposals that interfere with beneficiaries’ ability to affirmatively choose their own coverage. Beneficiaries should not be pushed into plans they did not choose freely.

The Negatives

Backsliding on Marketing Limitations

Unfortunately, much of the rule would undermine beneficiary safeguards by allowing marketers to blur distinctions between educational events and sales pitches, permitting call centers to collect private data from beneficiaries without telling them what plans they are selling, and eliminating buffers that currently let prospective enrollees seek feedback or other help from friends and family.

Another proposal we strongly oppose would allow marketers to stop pointing callers to State Health Insurance Assistance Programs (SHIPs) which provide objective, free, one-on-one assistance to Medicare beneficiaries, their families, and caregivers. This would increase reliance on biased information sources like agents and brokers and create unnecessary hardships for beneficiaries.

We urged CMS to withdraw these proposed changes. Instead, more should be done to ensure plan marketing is limited, straightforward, clear, and honest.

Denying Important Information to Enrollees

Other aspects of the rule would further limit the information plans must share with beneficiaries. One such proposal would withdraw a requirement for plans to notify enrollees about unused supplemental benefits and how to access them. We supported the creation of this notification because although many people choose MA for supplemental benefits, they often go unused, suggesting access or other barriers. Helping people keep track of their benefits could improve utilization and clarify needed reforms.

Other proposals would eliminate requirements for plans to assess and publicly post whether they treat all enrollees fairly in prior authorization policies and procedures and excuse them from notifying enrollees that they can receive help and information in other languages.

We strongly oppose these efforts to limit not only information plans must provide enrollees or potential enrollees but also public accountability for bad plan behaviors.

Medicare Rights on the Record

In our comments, Medicare Rights spoke out against the negative proposals and in support of those that could help people with Medicare get the care they need. We will continue to urge CMS to withdraw or revise provisions that prioritize insurance companies over older adults and people with disabilities and that remove sources of accurate, unbiased assistance. In these days of affordability challenges and health system upheaval, Medicare must be a safe and stable bastion of high-quality care.

Read the proposed rule.

Read our comments on the proposed rule.