November 16, 2023

Warren, Cortez Masto, Cassidy, Blackburn Introduce Bipartisan Legislation to Increase Transparency Over Medicare Advantage Health Care Plans

Text of Bill (PDF)

Washington, D.C. —  U.S. Senators Elizabeth Warren (D-Mass.), Catherine Cortez Masto (D-Nev), Bill Cassidy (R-La.), and Marsha Blackburn (R-Tenn.) introduced bipartisan legislation to improve transparency of Medicare Advantage (MA) plans and ensure these plans are best serving the health care needs of America’s seniors. The Encounter Data Enhancement Act would require Medicare Advantage plans to report important information about how much they are actually paying for patient services and how much patients are responsible for paying out-of-pocket. 

In 2023, $454 billion (or 54%) of total federal Medicare spending went to Medicare Advantage—private insurance companies contracting with the federal government to provide Medicare coverage for over 30 million Americans. While the federal government already requires Medicare Advantage plans to report encounter data on services provided to beneficiaries, these records are often  incomplete or lackkey information that is essential to combat fraud and abuse. 

“For years, Medicare Advantage plans have been using a long list of tricks to overcharge the government for coverage, while delaying and denying care for seniors,” said Senator Warren. “By strengthening data transparency, this bipartisan bill will empower lawmakers and regulators to rein in this fraud and abuse, and ensure taxpayer dollars are being used to deliver high-quality coverage for Medicare beneficiaries.”

“American taxpayers are paying hundreds of billions of dollars for seniors to use Medicare Advantage plans, but the federal government still doesn’t know how much these plans are paying for patient services and how much patients are being forced to pay out-of-pocket,” said Senator Cortez Masto. “My bipartisan legislation will ensure these plans are transparent, helping us conduct appropriate oversight and provide seniors with the best possible health care coverage.”  

“Just as price transparency is good for patients, data transparency is good for the federal taxpayer,” said Dr. Cassidy. “Specifically, transparency allows taxpayers to better understand how the hundreds of billions of dollars going for Medicare programs is being used and answering the question of if the money can be better used.” 

“As the preference for Medicare Advantage grows among seniors because it provides more robust benefits beyond traditional Medicare, it becomes essential to encourage transparency in participating plans,” said Senator Blackburn. “This legislation accomplishes that by working to foster greater clarity in the billing practices of Medicare Advantage organizations, cultivating a more competitive and robust Medicare Advantage market for the benefit of future generations.”

The Encounter Data Enhancement Act would: 

  1. Provide researchers and policymakers with a much clearer understanding of plan payments to providers and how much patients are required to pay for services.

  2. Help lawmakers conduct oversight of federal dollars going to Medicare Advantage plans. 

  3. Assess quality of care, and strengthen health care access for America’s seniors. 

Senator Warren has led the fight to increase oversight of Medicare Advantage

  • On November 9, 2023, at a Senate Finance Committee markup of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, Senator Warren highlighted the need to strengthen transparency in Medicare Advantage, securing commitments from Senate Finance Committee leadership to prioritize these proposals in future packages.
  • In October 2023, at a hearing of the Senate Finance Committee, Senator Warren called out giant Medicare Advantage insurers for using deceptive marketing tactics to lure seniors into the wrong plans and drown out competition from smaller insurers that may offer better coverage. Senator Warren called on the Centers for Medicare and Medicaid Services (CMS) to act within the fullest extent of its authority to crack down on MA insurers that game the system to overcharge the government and to ensure insurers publish accurate data on patient care and out-of-pocket costs.
  • In May 2023, at a hearing of the Senate Finance Committee, Senator Warren highlighted the prevalence of ghost networks in Medicare Advantage plans and called for stronger oversight of the program. In response to questions from Senator Warren, Mary Giliberti, Chief Public Policy Officer at Mental Health America, pointed out the alarming number of inaccuracies in Medicare Advantage plan provider directories, the effects of these errors on network adequacy, and the impact for patients.
  • In March 2023, at a hearing of the Senate Finance Committee, Subcommittee on Health Care, Senator Warren questioned Chief Economist and Vice President of the American Dental Association’s Health Policy Institute Dr. Marko Vujicic and Meharry Medical College Dean and Professor Dr. Cherae M. Farmer-Dixon on the disparities in dental coverage for seniors in traditional Medicare and Medicare Advantage. Senator Warren highlighted how low-quality dental coverage in MA leads to high out-of-pocket costs that make beneficiaries less likely to access care.
  • In March 2023, Senators Warren and Jeff Merkley (D-Ore.) sent letters to the top seven Medicare Advantage insurers – Humana, Centene, UnitedHealthcare, CVS/Aetna, Molina, Elevance Health, and Cigna – regarding their questionable claims that the Centers for Medicare and Medicaid Services’ (CMS) 2024 proposed Medicare Advantage payment rules would hurt beneficiaries. The lawmakers asked the insurers to explain why the changes proposed by CMS would lead the companies to increase premiums or reduce benefits for beneficiaries at a time when they were raking in enormous profits and paying millions to their executives and shareholders each year.
  • In March 2023, at a hearing of the Senate Finance Committee, Senator Warren defended the Centers for Medicare and Medicaid Services (CMS) proposed adjustments to the Calendar Year 2024 Medicare Advantage payment rates, pushing back against giant insurance companies and their lobbyists who are peddling misinformation to protect their billions in profits and scare beneficiaries into opposing the rule. Senator Warren debunked industry talking points and exposed how MA plans take advantage of loopholes to squeeze billions of additional dollars out of the Medicare program, resulting in profit margins that are double those for other types of insurance. Senator Warren further clarified that, despite industry promises to provide Medicare benefits for less, the private insurance companies running MA have never delivered health care at a lower cost than traditional Medicare in the entire history of the program.
  • In April 2022, Senator Warren and U.S. Representatives Katie Porter (D-Calif.), Rosa DeLauro (D-Conn.), and Jan Schakowsky (D-Ill.) led their colleagues in sending a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure highlighting concerns about overpayments to Medicare Advantage plans that line the pockets of big insurance companies. The letter urges CMS to mitigate the announced payment increases so they are on par with payments to Traditional Medicare. Sent by a total of 19 members of the Senate and the House, the letter also calls on CMS to increase transparency in the Medicare Advantage program.