March 16, 2023 Washington, DC — LeadingAge, the association of nonprofit providers of aging services, today unveiled a series of solutions to the critical and growing failures of Medicare Advantage (MA) to provide equitable access to needed post-acute services. The new report, Fulfilling the Promise: Medicare Advantage, explains the issues and offers policy recommendations. 

Nearly half of America’s Medicare beneficiaries are MA enrollees — more than 30 million people – who, too often, encounter challenges accessing quality health care and basic Medicare services, which may have life-or-death consequences. At the root of many MA issues: problematic contracting policies and procedures, from paltry payment rates that do not cover the cost of services and by doing so limit consumers’ access to quality providers, to delayed approvals on care requests. 

“Whether it’s delayed claims processing and opaque explanations for prior authorizations or slow care approvals, MA plan practices and policies impact the entire health care system,” said Katie Smith Sloan, president and CEO, LeadingAge. “Failure to address these and a host of other issues now will jeopardize the health and well-being of millions of older adults as the MA juggernaut expands. The time is right to take action.”

Over the past year, both Congress and the Office of Inspector General (OIG) have raised concerns about MA plan practices and beneficiary access to care, causing the Centers for Medicare & Medicaid Services (CMS) to step up its MA plan practices scrutiny. LeadingAge, responding to the agency’s numerous requests for information laid out in detail the challenges its nonprofit, mission-driven members encounter in navigating MA plan policies and practices in an effort to serve older adults who need care (CMS-4203-NC August 2022, CMS-4201-P February 2023 and CMS-0057-P March 2023). 

“We’re at a critical point as MA plans expand,” she continued. “Our members’ experiences and challenges in serving older adults while dealing with myriad plan policies are at the heart of the Fulfilling the Promise report and the reason we’re intensifying our advocacy on these issues.  Medicare beneficiaries deserve to receive the care they need, and providers, who deliver it, deserve to be paid in predictable, fair, and straightforward ways. We can do better.” 

LeadingAge’s solutions, described below, could be achieved administratively through action by the Centers for Medicare & Medicaid Services (CMS). Failing that, Congress must take steps on program modifications as well. 

Solutions include: 

• Make payment rates adequate and predictable.
• Understand and address challenges with prior authorization. 
• Bring the vision of high-quality care closure to routine practice by making value-based payments workable.
• Ensure beneficiaries have a true choice of high-quality providers by addressing MA plan network adequacy.
• Address transparency concerns by improving data collection and sharing.
• Actively support beneficiaries’ needs and rights. 

  “Our rapidly aging population, combined with MA’s growing domination of the insurance market that older adults rely on, warrants a close look at all Medicare programs to ensure older adults can access the care they need in effective, cost-efficient ways,” said Sloan. “In order for Medicare programs to achieve their goals, policies must meet the needs of both beneficiaries and the organizations that serve them.”  

We represent more than 5,000 nonprofit aging services providers and other mission-minded organizations that touch millions of lives every day. Alongside our members and 38 state partners, we use applied research, advocacy, education, and community-building to make America a better place to grow old. Our membership, which now includes the providers of the Visiting Nurse Associations of America, encompasses the continuum of services for people as they age, including those with disabilities. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information visit leadingage.org.