Fact-checking ads about Biden cuts to Medicare Advantage

Potential cuts to Medicare benefits have been a hot topic among US lawmakers in recent months.

Now, a recent ad claims that President Joe Biden’s administration is proposing a cut to Medicare Advantage, sometimes referred to as “Part C.”one of the ads share on twitter It claims that cuts will deprive individual members of their interests.

Many VERIFY readers have also questioned whether it is true that the Biden administration is proposing to cut the Medicare advantage.

question

Is the Biden Administration Proposing Cuts to Medicare Advantage Plan Benefits?

source of information

answer

No, the Biden administration is not proposing to cut Medicare Advantage Plan benefits.

The federal government has proposed changes to how insurance companies that offer Medicare Advantage are paid, but these changes do not require a reduction in benefits for subscribers.

what we found

Medicare is federal health insurance for everyone over the age of 65 and for people under the age of 65 with certain disabilities and conditions. It consists of 4 parts A, B, C and D.

Traditional Medicare provided by the federal government includes Part A hospital insurance and Part B medical insurance.

Medicare Advantage PlanSometimes called Part C, it is provided by a private company approved by Medicare, not by the federal government. These plans offer Part A and Part B coverage.

Most Medicare Advantage Plans include It’s Part D prescription drug coverage and may offer additional benefits like vision, hearing, and dental coverage that aren’t included as part of traditional Medicare.

More from VERIFY: The shingles vaccination is free for Medicare Part D patients as of January 2023.

Several recent ads claim the Biden administration is proposing “massive cuts” to Medicare Advantage. Funded by the network.

Two recent announcements from the Biden administration may be behind claims about cutting Medicare Advantage benefits.

The first, a rule change that will allow the federal government to recover past overpayments to Medicare Advantage insurance companies, is scheduled to go into effect in April 2023. Second, the federal government recently announced proposed updates to payment methods for Medicare Advantage insurance companies beginning in 2024. .

But the Biden administration has not proposed cutting Medicare Advantage benefits for seniors. U.S. Department of Health and Human Services (HHS) says a Medicare expert.

Here’s a breakdown of these proposed changes:

rule change

of rule change It is scheduled to enter into force on April 3, 2023. This will change the federal audit process for Medicare Advantage insurers to allow overpayments to be recovered.

Studies and Federal Audits Show “Private Insurers Overbilled Medicare Advantage Plans Billions of Dollars” Diagnosis not supported by the patient’s medical recordaccording to HHS and the Centers for Medicare and Medicaid Services (CMS).

CMS is required by law to “guarantee accurate payments and prevent fraud, waste and abuse.” Audits, which are part of that process, are “not clearly curtailed,” according to HHS.

Other proposed changes change how we pay Medicare Advantage insurers

Medicare and Medicaid Service Centers (CMS) shared advance notice In early February, we outlined federal proposals to pay for Medicare Advantage Plans in 2024.

Some of the proposed changes would cut payments to Medicare Advantage insurers, but Medicare and Medicaid Service Center (CMS) Quote The overall effect of the proposed policy and other changes is to increase payouts to insurers per policyholder by 1% in 2024.

Because of this increase, HHS claims the Biden administration “has not cut payments to Medicare Advantage.”

So what do these proposed changes do?

Some affect Medicare Advantage’s risk-adjusted model, which essentially determines how much the federal government pays insurance companies based on a patient’s diagnosis.

The proposed change would make the risk-adjusted model “less lenient on the plan,” said Robert Berenson, M.D., a Medicare expert at the Urban Institute who expressed support for the proposed change.

However, according to Berenson, the risk adjustment change does not reduce the benefits of registrants.

“Health insurance will pay less, but the beneficiaries won’t have to lose anything,” he said.

It will depend on the insurance company.

Jeannie Fugresten Biniek, associate director of the Kaiser Family Foundation’s Medicare Policy Program, said the change was more accurately viewed as “improving the accuracy of payments to Medicare Advantage Plans,” rather than as a reduction. I’m here.

Some industry insiders such as Better Medicare Allianceargues these changes will result in insurers reducing benefits or increasing premiums for Medicare Advantage participants. I’m here.

“These plans are currently being paid heavily by the federal government. They have plenty of cushion,” she said. are competing in [and] A plan with powerful additional benefits. This is an attractive market in which they participate. “

Insurers can cut administrative costs, cut marketing costs or cut some of their profits before cutting benefits, which is how they stay competitive in the market, she said. Added.