Better Medicare Alliance Calls for Expanded Regulation of TPMOs to Strengthen Protections for Seniors and Increase Transparency in Medicare Advantage
BMA provides additional recommendations in comments to CMS on CY 2025 Proposed Rule to modernize the program for 31 million beneficiaries
WASHINGTON — Better Medicare Alliance (BMA), the nation’s leading research and advocacy organization supporting Medicare Advantage, shares the Centers for Medicare & Medicaid Services’ (CMS) goals to ensure that beneficiaries receive accurate, complete information about their Medicare choices. To that end, BMA today urges CMS to expand its regulatory authority by bringing third-party marketing organizations (TPMOs) into the existing regulatory structure to help level the playing field and provide common sense guardrails for all sales and marketing organizations.
As part of its response to CMS’ CY 2025 Proposed Rule, BMA proposes Medicare Advantage marketing recommendations that build on its 2023 policy solutions and empower beneficiaries to choose the health plan that best suits their needs.
While BMA shares CMS’ goals to provide clear, accurate information to beneficiaries, there remain concerns that CMS’ current proposal creates ambiguity around contract terms and does not include regulation of TPMOs. BMA recommends that CMS maintain the current regulatory framework as it relates to agents and brokers and expand its regulatory authority to TPMOs. BMA also asks that CMS clearly define the types of administrative services for which health plans can compensate TPMOs, establish a fee cap for administrative services, and prohibit TPMOs from distributing beneficiary contact information. Together, these reforms will ensure that beneficiaries have access to all necessary information to make a well-informed decision.
“Expanding the regulation of TPMOs will better ensure accuracy and transparency in marketing and selling Medicare Advantage plans to help beneficiaries choose the plan that best meets their needs,” said Mary Beth Donahue, President and CEO of the Better Medicare Alliance. “We are fully committed to modernizing Medicare Advantage, which is why we strongly support marketing policies aimed at improving the decision-making tools for millions of beneficiaries and share CMS’s goal to level the marketing playing field.”
“Accurate marketing in Medicare Advantage is not just a health policy issue, it’s a health equity issue,” said Dennis Borel, Executive Director of the Coalition of Texans with Disabilities. “Persons with disabilities depend on accurate, reliable marketing information to make informed choices for their health care. The Coalition of Texans with Disabilities is proud to support Better Medicare Alliance’s recommendations for modernized Medicare Advantage marketing standards. With many people with disabilities dually eligible for Medicaid because of limited financial resources, truthful and clear communication is critical for beneficiaries’ ability to choose the right Medicare coverage for their needs.”
“As an organization dedicated to transforming the current healthcare system to achieve equitable, patient-centered outcomes, we recognize how critical it is for beneficiaries to have the accurate information needed to make fully informed decisions about their health coverage,” said Jeff Micklos, Executive Director of the Health Care Transformation Task Force. “Better Medicare Alliance’s recommendations to strengthen CMS oversight of Medicare Advantage marketing practices represent clear steps in the right direction to improve the program for the millions of beneficiaries that rely on it.”
In addition to its marketing recommendations, BMA’s comment letter on the CY25 Proposed Rule provided further considerations in the following areas to modernize and strengthen Medicare Advantage for all beneficiaries:
- Supplemental Benefits in Medicare Advantage: We encourage CMS to explore expanded use of preexisting channels of communications and mechanisms that beneficiaries could be notified of their supplemental benefit offerings and availability that are already a part of the Medicare Advantage plan experience and communications in lieu of the proposed mid-year notification to mitigate beneficiary confusion. BMA supports the proposal regarding the evidence for offering Special Supplemental Benefits for the Chronically Ill (SSBCI) and intends to collaborate with our Allies and partners to develop a catalog or comprehensive resource that supports the offering of SSBCI as we are uniquely positioned to do so.
- Improvements for Special Needs Plans: BMA appreciates CMS’ goal and efforts to improve the experience and outcomes for dual eligible beneficiaries. We support CMS’ proposal to limit D-SNP look-alike plans by lowering the threshold over two years if partial dual eligible beneficiaries are excluded from the threshold assessment. Additionally, we are concerned the totality of CMS’ remaining proposals could significantly limit beneficiary choice and disrupt care. BMA recommends that CMS preserve the Medicare Advantage choice for dual eligible beneficiaries, focus on highlighting the potential value of aligned enrollment over limiting enrollment in non-integrated health plans, and explore how further integration impacts the physician and the provider community.
- Expanding Network Adequacy Requirements for Behavioral Health: BMA supports CMS’ efforts to improve access to behavioral health services for Medicare Advantage beneficiaries with behavioral health needs, and supports the new provider specialist types CMS proposes in the facility-specialty, Outpatient Behavioral Health. We encourage CMS to consider adding these specialists at the provider level rather than facility level to minimize potential confusion for beneficiaries when navigating their options.
- Annual Health Equity Analysis of Utilization Management Policies and Procedures: BMA shares CMS’ goal of ensuring timely and appropriate access to medically necessary care for beneficiaries enrolled in Medicare Advantage and appreciates CMS’ focus on health equity in the prior authorization process. We generally support the inclusion of an individual with expertise in health equity on the Utilization Management Committee recently established.
BMA looks forward to continuing to work with CMS to collectively meet our shared goals and support the more than 31 million beneficiaries that Medicare Advantage serves. BMA will remain a resource for CMS as the CY 2025 Proposed Rule process continues.
Read the full comment letter HERE.
Better Medicare Alliance is a community of more than one million grassroots beneficiaries and 200+ Ally organizations working to improve health care through a strong Medicare Advantage. Learn more at www.bettermedicarealliance.org.
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