Bill Overview
Title: Medicare Advantage Consumer Protection and Transparency Act
Description: This bill generally requires Medicare Advantage organizations to report additional information to the Centers for Medicare & Medicaid Services, including supplemental plan benefits, encounter data, and the number of coverage denials and prior authorization requests. Failure to comply with the bill's requirements may result in payment reductions.
Sponsors: Rep. Porter, Katie [D-CA-45]
Target Audience
Population: People enrolled in Medicare Advantage plans
Estimated Size: 30000000
- The bill specifically targets Medicare Advantage organizations, which are private companies that provide Medicare benefits.
- Medicare Advantage plans are chosen by beneficiaries who prefer an alternative to the Original Medicare program, often due to additional benefits offered.
- As of 2023, there are about 30 million beneficiaries enrolled in Medicare Advantage plans in the United States.
- The legislation is likely to directly affect the operational procedures of Medicare Advantage organizations, potentially influencing their offerings.
- Indirectly, the bill will impact beneficiaries of these plans if changes are made to plan benefits, premiums, or availability due to compliance costs or adjustments.
Reasoning
- The target population of 30 million individuals enrolled in Medicare Advantage plans is diverse in terms of age, health conditions, income levels, and geographic distribution.
- Since the policy demands more reporting and transparency from Medicare Advantage organizations, larger plan providers may adjust offerings or prices depending on compliance costs.
- Beneficiaries are concerned about potential coverage denial changes, additional transparency could lead to improved plan satisfaction if communicated well.
- The policy's impact will vary based on how each Medicare Advantage organization adapts, which can lead to differing impacts at an individual level.
- The policy must operate within budget constraints, therefore transparency improvements might not immediately translate to enhanced benefits.
Simulated Interviews
retired (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- I like the additional benefits my plan offers, but sometimes the paperwork can be confusing.
- More transparency sounds good, but I hope they don't cut benefits because of any extra costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
part-time consultant (California)
Age: 68 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- It’s so important to have transparency because I travel a lot and need to know exactly what is covered.
- I just hope they don't increase premiums.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
retired teacher (Texas)
Age: 75 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I often get coverage denials on medications, so this policy might help if it leads to fewer denials.
- I hope my premiums don't rise.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
retired (New York)
Age: 65 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- More information about denials and plan benefits is beneficial, I feel like I am in the dark sometimes.
- But I am worried about how quickly plans might change and adapt to this new policy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
retired (Illinois)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- I’m already happy with my plan, but any steps towards more transparency can only be good.
- I doubt it will directly affect me much but it's good for overall trust.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
retired engineer (Ohio)
Age: 78 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- More transparency might lead to better understanding of my rights and options.
- I'm mostly worried about potential cost increases or loss of coverage benefits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
retired nurse (Michigan)
Age: 67 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 3.0 years
Commonness: 8/20
Statement of Opinion:
- As a former nurse, I appreciate transparency because it helps in making informed decisions.
- My only issue would be if they cut any of the great benefits we currently receive.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 7 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
semi-retired (Arizona)
Age: 69 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- The idea of knowing more about coverage denials is reassuring.
- It's unclear how the policy effects will be visible to us beneficiaries immediately.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
retired librarian (Virginia)
Age: 76 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- I have curly questions on coverage denials and knowing more might help.
- Potentially higher premiums are a concern though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
recently retired (Washington)
Age: 64 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- As someone who still figures out their plan, more clarity would help.
- Cost changes are a looming concern.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
Cost Estimates
Year 1: $50000000 (Low: $40000000, High: $60000000)
Year 2: $55000000 (Low: $45000000, High: $65000000)
Year 3: $60500000 (Low: $49000000, High: $72000000)
Year 5: $71000000 (Low: $57000000, High: $85000000)
Year 10: $94000000 (Low: $75000000, High: $113000000)
Year 100: $940000000 (Low: $750000000, High: $1120000000)
Key Considerations
- The scale and specificity of additional reporting requirements.
- The capacity and readiness of CMS to manage and utilize increased data.
- Compliance costs for Medicare Advantage organizations.