Fact-checking ads about Biden cuts to Medicare Advantage

Potential cuts to Medicare advantages were a sizzling subject for U.S. lawmakers in contemporary months. 

Now, contemporary ads declare President Joe Biden’s management is proposing cuts to Medicare Advantage, often referred to as “Part C.” One of the ads shared via Twitter alleges that the cuts would remove advantages for person individuals. 

Many VERIFY readers have additionally requested if it’s true that the Biden management is proposing cuts to Medicare Advantage. 

Is the Biden management proposing cuts to Medicare Advantage plan advantages?

No, the Biden management isn’t proposing cuts to Medicare Advantage plan advantages. 

The federal executive has proposed adjustments to how insurance coverage corporations that provide Medicare Advantage are paid, however the ones adjustments don’t require advantages cuts for enrollees. 

Medicare is federal medical insurance for somebody age 65 and older, and a few folks below 65 with sure disabilities or prerequisites. It’s made up of 4 portions: A, B, C and D. 

Traditional Medicare introduced through the government comprises Part A clinic insurance coverage and Part B health insurance. 

Medicare Advantage plans, often referred to as Part C, are introduced through personal corporations licensed through Medicare, relatively than the government. Those plans will supply your Part A and Part B protection. 

Most Medicare Advantage plans additionally include Part D prescription drug protection, and would possibly supply further advantages corresponding to imaginative and prescient, listening to and dental protection that aren’t integrated as a part of conventional Medicare. 

More from VERIFY: Shingles shot is now loose for folks with Medicare Part D as of January 2023

Some of the new ads declare the Biden management is proposing “massive cuts” to Medicare Advantage that might cut back advantages through masses of bucks in step with retiree. At least a type of ads is funded through the American Action Network, a conservative factor advocacy crew.

Two contemporary bulletins from the Biden management are most likely in the back of the claims about cuts to Medicare Advantage advantages. 

One is a rule trade that may permit the government to get well previous overpayments to Medicare Advantage insurers and is about to take impact in April 2023. Second, the government not too long ago introduced a proposed replace to how Medicare Advantage insurers can be paid beginning in 2024.

But the Biden management isn’t proposing cuts to Medicare Advantage advantages for seniors, the U.S. Department of Health and Human Services (HHS) and Medicare professionals say.

Here’s a breakdown of the ones proposed adjustments.

The rule change is about to take impact on April 3, 2023. It will regulate the government’s technique of auditing Medicare Advantage insurers, permitting it to recoup overpayments. 

Studies and federal executive audits “have shown that private insurance companies have charged billions of dollars in overpayments to Medicare Advantage plans” for diagnoses that were not supported by a patient’s medical record, in accordance to HHS and the Centers for Medicare and Medicaid Services (CMS). 

CMS is needed through legislation to “ensure accurate payments and prevent fraud, waste, and abuse.” Audits, that are a part of that procedure, are “unequivocally not cuts,” in accordance to HHS. 

Other proposed adjustments would regulate how Medicare Advantage insurers are paid

The Centers for Medicare and Medicaid Services (CMS) shared an advance notice in early February outlining the government’s proposals for paying Medicare Advantage plans in 2024. 

While one of the crucial adjustments within the proposal will cut back bills to Medicare Advantage insurers, the Centers for Medicare and Medicaid Services (CMS) estimates that the entire impact of proposed insurance policies and different adjustments can be a 1% build up in bills to insurers in step with enrollee in 2024. 

Because of this build up, HHS asserts that the Biden management “is not reducing payments to Medicare Advantage.”

So what do those proposed adjustments do? 

Some would affect the danger adjustment fashion for Medicare Advantage, which necessarily determines how a lot the government will pay insurers in keeping with affected person diagnoses. 

The proposed adjustments would make the danger adjustment fashion “less generous to the plans,” Robert Berenson, M.D., a Medicare skilled with the Urban Institute who has expressed enhance for the proposed adjustments, mentioned. 

But the danger adjustment adjustments don’t quantity to a minimize in advantages for enrollees, in accordance to Berenson. 

“There will be less payments going to the health plans, but there’s no requirement that beneficiaries lose anything,” he mentioned. 

That can be up to the insurance coverage corporations.

Jeannie Fuglesten Biniek, affiliate director of the Program on Medicare Policy at Kaiser Family Foundation, mentioned it’s extra correct to believe the adjustments as the ones which might be “improving the accuracy of the payments to Medicare Advantage plans,” relatively than cuts. 

Some trade stakeholders, such because the Better Medicare Alliance, declare that those adjustments will lead insurers to minimize advantages or build up premiums for Medicare Advantage enrollees. But Fuglesten Biniek mentioned she thinks that end result is not likely.

“These plans have generous payments right now from the federal government. They have a good amount of cushion,” she mentioned. “In addition, they compete by offering plans with zero supplemental premiums [and] plans that have robust extra benefits. This is an attractive market for them to participate in.”

Insurers can decrease administrative prices, cut back their advertising bills or minimize a few of their income sooner than reducing advantages, that are how they continue to be aggressive available in the market, she added.