Curb Medicare Advantage Funding, Sen. Warren Asks CMS

What You Need to Know

Nine senators joined Elizabeth Warren of Massachusetts in a public letter to the administration.
The group says the government should cut about $100 billion of what it spends annually on the private program.
The senators also want program managers to reduce plan preauthorization red tape and claim denials.

A coalition of 10 U.S. senators is asking the Biden administration to be tough on the Medicare Advantage program in 2025.

Sen. Elizabeth Warren, D-Mass., and nine colleagues are urging Medicare managers to save about $100 billion of the $400 billion they spend on the Medicare Advantage program each year by tightening the rules for how the plan issuers rate the health of plan participants.

“We dispute claims that such efforts could result in higher premiums or reduced benefits,” Warren and her colleagues write in a public letter addressed to Xavier Becerra, the Health and Human Services secretary, and Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services.

Warren and her colleagues wrote in response to the preliminary CMS Medicare Advantage and Medicare Part D prescription drug plan rate announcement for 2025. The advance notice is part of the Medicare plan bidding process. CMS said it will post the final rate notice by March 31.

What it means: In some cases, opposition to the Medicare Advantage program in the Senate could complicate efforts to pass health finance legislation there.

But the Medicare Advantage program still appears to have strong, bipartisan support in the Senate.

In January, a Nevada Democrat, Sen. Catherine Cortez-Masto, helped lead a team that sent CMS a letter asking for stability for the program.

The list of the 60 signers of that letter included 18 Democrats and two independents who caucus with the Democrats. One of the Democrats who signed that letter was Majority Leader Chuck Schumer of New York.

Medicare Advantage: Because of the nature of the federal legislation that created Medicare, original Medicare coverage exposes enrollees to many deductibles, co-payment requirements and coinsurance bills.

About 14 million of the 67 million Medicare enrollees fill in the gaps by buying Medicare supplement insurance, which is under the jurisdiction of state insurance regulators.

Roughly 33 million use private insurers’ Medicare Advantage plans to provide what looks like an alternative to original Medicare. Plan managers fill in most of the original Medicare “cost sharing” gaps in exchange for encouraging enrollees to use in-network providers and let the plans manage the enrollees’ use of care.