At
the
annual
Medicarians
conference
in
Las
Vegas
on
Monday,
an
analyst
on
Medicare
Advantage
policy
research
sounded
the
alarm
about
how
there’s
a
fundamental
shift
in
attitude
towards
MA
at
the
federal
level.
It’s
a
combination
of
several
factors:
deep
concerns
over
overpayment
and
fraud,
resulting
in
legislative
and
political
scrutiny
on
insurers;
3
million
seniors
losing
their
MA
coverage
in
2026
because
health
insurers
pulled
out
of
their
counties;
and
large
and
small
public
insurance
companies
faring
badly
at
the
stock
market.
Especially
at
the
Centers
for
Medicare
and
Medicaid
Services,
overpayments
have
become
a
sticking
point.
“CMS
has
begun
shifting
to,
I
think
a
more
adversarial
posture
when
it
comes
to
how
they
view
Medicare
Advantage,”
said
Tom
Kornfield,
founder
and
CEO
of
MAST
Health
Policy
Solutions.
“And
that’s
before
we
even
get
into
what
happens
under
an
election
season,
which
is
when
the
rhetoric
gets
turned
up
to
11,
to
quote
Spinal
Tap.”
The
Medicarians
conference
brings
together
healthcare
and
life
insurance
brokers,
agents,
owners
of
brokerages
as
well
as
independent
marketing
organizations
and
field
marketing
organizations
that
serve
as
a
liaison
between
an
insurance
carrier
and
an
agent.
The
attendees
are
united
by
the
single
goal
of
understanding
the
needs
of
seniors
and
fulfilling
those
needs
by
selling
insurance
products
—
whether
health
or
financial
—
to
them.
The
conference
also
draws
agents
and
companies
involved
in
the
Affordable
Care
Act
marketplace.
Kornfield
said
that
CMS’s
scrutiny
is
also
falling
on
Chronic
Care
Special
Needs
Plans.
“The
concern
about
them
from
CMS
is
that
they
are
bypassing
some
of
the
requirements
for
the
Dual
Eligible
Special
Needs
Plan,”
he
declared.
“So
I
think
we
could
see
some
activity
on
that
front.”
He
added
that,
depending
on
the
outcome
of
the
midterms
—
especially
if
Democrats
win
—
he
expects
to
see
a
lot
of
activity
in
terms
of
regulation
and
legislative
changes
affecting
MA.
While
more
seniors
are
enrolled
in
MA
plans
today
compared
with
traditional
Medicare,
enrollment
in
MA
plans
is
slowing
across
the
board,
except
in
Special
Needs
Plans
or
SNPs.
In
2021,
MA
enrollment
was
at
11%;
in
2026
it
was
3%.
Whether
CMS
and
other
federal
agencies
are
zeroing
in
on
fraud
or
controlling
overpayment,
a
lot
of
the
negative
headlines
about
MA
stem
from
the
fact
that
year
after
year,
costs
keep
going
up.
The
latest
MedPAC
report
shows
that
MA
payments
were
$76
billion
above
what
spending
would
have
been
if
those
same
seniors
were
enrolled
in
traditional
Medicare
instead.
And
that
is
especially
hard
to
stomach
given
that
when
Medicare
Advantage
was
conceived
legislatively,
it
was
not
only
to
provide
more
choice
to
seniors
but
also
to
hold
down
healthcare
costs
that
are
funded
by
taxpayer
dollars.
But
the
scrutiny
is
not
only
about
the
cost
of
MA.
“So
there
are
the
MedPAC
numbers
that
I
mentioned,
and
there’s
also
been
increased
scrutiny
by
the
administration
of
what
they
think
is
waste
going
on
within
the
Medicare
Advantage
plans
or
fraud
even
with
risk
adjustment,
data
validation
audits,
which
is
where
they
go
in,
review
medical
records,
see
if
that
diagnosis
is
supported
by
the
medical
record,”
Kornfield
pointed
out.
Other
than
ballooning
costs,
the
national
souring
on
MA
also
has
to
do
with
activity
of
health
insurance
marketing
organizations,
even
though
Kornfield
was
careful
not
to
castigate
his
audience
members,
the
overwhelming
majority
of
whom
were
agents
and
brokers.
“During
Covid,
unfortunately,
not
trying
to
assign
blame,
but
because
of
the
probably
call
center-related
[issues],
there
were
plenty
of
complaints
about
marketing
and
that
got
the
attention
of
people
on
the
Hill
and
that’s
a
real
problem.,”
he
said.
“And
that
may
not
be
as
big
of
a
problem
now,
but
I
think
there’s
still
a
hangover
from
that.”
All
in
all,
the
MA
market
is
in
the
middle
of
a
fundamental
shift.
“Medicare
Advantage
is
really
at
an
inflection
point,”
Kornfield
declared.
“So
this
isn’t
really
a
rough
patch.
It’s
not
a
cycle.
It’s
really
a
reset.”
Will
this
dynamic
shift
depend
on
the
outcome
of
midterms?
Will
it
be
better
for
brokers,
insurers
and
the
MA
industry
if
Democrats
sweep
the
midterms
or
Republicans
are
able
to
hold
the
line?
“I
would
think
that
the
Democratic
Congress
would
be
much
more
active
in
bringing
the
health
plans
up
there,”
Kornfield
said.
“There
is
concern
about
the
size
of
these
large-scale
companies,
these
insurers,
UnitedHealthcare.
There’s
been
a
lot
of
negative
publicity
about
the
health
insurers.”
But
the
host
of
the
compliance
track
where
Kornfield
was
speaking
saw
it
differently.
He
saw
equal
concern
from
both
sides
of
the
aisle.
“They
want
to
see
the
cost
to
the
taxpayer
of
Medicare
Advantage
as
a
program
go
down,
and
this
is
Democrats
and
Republicans,
guys
don’t
get
confused,”
Steve
Kaplan,
chief
legal,
compliance,
and
privacy
officer,
at
HealthPlanOne,
told
the
audience.
“And
so
they’re
like,
‘How
can
agents
and
brokers
help?’”
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