August 7, 2024 Washington, DC – Citing the negative impact of Medicare Advantage (MA) plans’ aggressive and misleading marketing practices on older adults served in Programs for All-Inclusive Care for the Elderly (PACE) programs, two national associations representing PACE organizations urge the Centers for Medicare and Medicaid Services (CMS) to strengthen oversight to protect beneficiaries from harm. 

In a July 25 letter to CMS administrator Chiquita Brooks-LaSure, the National PACE Association, the national association representing all current PACE organizations, and LeadingAge, the national association of nonprofit and mission-driven providers of aging services, including PACE, explain how the marketing of cash supplements, in the form of debit cards, by MA plans is misleading older adults and disrupting their access to needed services provided to them by PACE organizations .   

“We share CMS’ stated desire that people have access to accurate and complete information when they make health care choices,” said Shawn Bloom, President and CEO of the National PACE Association.  “We have numerous examples of vulnerable seniors being induced to enroll in MA plans without being fully-informed of what they are giving up when they enroll.”

“The financial and health implications of uninformed disenrollment from PACE to conventional MA plans are significant,” adds Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services: “The needs of PACE beneficiaries, most of whom have multiple complex medical conditions, cognitive or functional impairments – or all three – are not comprehensively addressed by MA plans. The loss of PACE services is harmful and, in some cases, can be life-threatening.”  

In addition, the organizations write, these marketing practices not only distort healthy competition among Medicare beneficiaries’ coverage options but, more importantly, pose significant and potentially dire health risks for affected enrollees when considering access, cost, and coverage differences between and among plans.

Stronger enrollee protections are needed, the letter stated, to ensure that beneficiaries have accurate and appropriate information to make a fully informed decision prior to enrolling in a MA plan. This is especially critical for PACE participants for whom disenrollment from their integrated PACE plan would likely result in increased out-of-pocket costs and far less comprehensive coverage. 

The letter called on CMS to implement a series of changes: 

• Require MA plans to explain all out-of-pocket costs and network/coverage limitations clearly and fully, based on standardized language, to prospective enrollees prior to their enrollment in a MA plan. 
• Stipulate additional measures during the PACE participant voluntary disenrollment process (42 CFR § 460.162 ) – e.g., requiring written revocation of PACE coverage analogous to the Medicare hospice benefit – to ensure the authenticity and intentionality of the participant’s voluntary disenrollment.  
• Permit mid-month enrollment in PACE for former PACE participants to re-enroll in PACE if beneficiary wants to return to PACE following their disenrollment from a MA plan.  
• Clarify that when MA brokers inform beneficiaries of the comparative benefits of their current coverage (e.g., PACE) to an alternate MA plan that the broker inform them, in plain language, if they would be enrolling in a plan that does not cover or coordinate their Medicaid benefits; and any benefits the individual would “lose” under the new plan (e.g., transportation to groceries).