Congressional Leaders Push Back on Medicare Advantage Nursing Home Denials, Other MA Issues

As the Centers for Medicare & Medicaid Services (CMS) looks into more oversight for Medicare Advantage (MA), some progressive lawmakers are urging caution over Medicaid Advantage plans – long lamented among those in the nursing home industry – over deceptive advertising and high rates of denial for services.

Members of Congress discussed pitfalls of Medicare Advantage plans during a press briefing on Thursday, including denials of nursing home admissions and delays in medically necessary care, even as MA plans increase their own profits, speakers said. Lawmakers called for an overhaul of the insurance option, which they called a less comprehensive private health insurance compared to traditional Medicare.

The press briefing was held during the halfway point for national open enrollment.


Specifically, MA plans must be penalized for inappropriate denials and delays of care, the representatives said.

Rep. Mark Takano (D-Calif.) had an example from one of his constituents of denials under Medicare Advantage. The constituent’s husband was denied admission to a skilled nursing facility, as well as standard tests for cardiac patients with abnormal EKGs, transportation and MRI scans required for surgery, Takano said.

“This woman who told me the story, she had advanced degrees. She had the intellectual tools to be able to deal with these insurance companies and claims people,” said Takano. “I lie awake at night worried about the tens of thousands of people in my district, whose partner may not have the language skills to contend with these companies nor even the time of day – some of these people are still working. It is on Congress to demand greater regulation.”


Coupled with the press briefing, the group of lawmakers sent three letters to CMS telling the agency to strengthen their oversight of MA, while addressing inappropriate delays and denials of care along with overpayment to the insurance companies.

MA plans this year were overcharging taxpayers by as much as $140 billion, according to Rep. Mark Pocan (D-Wis.). That money could be better spent strengthening traditional Medicare, or expanding MediGap coverage, he said.

“American seniors are bombarded right now with deceptive advertising, during the time of year for open enrollment,” said Pocan. “They don’t know that they’re getting this pale alternative, often through this advertisement of Medicare. They may not know that what they’re really signing up for is possible denials or delays of medically necessary care.”

“Medicare disadvantage has led to worse outcomes for patients and higher costs for taxpayers,” said Rep. Pramila Jayapal (D-Wash.). “These plans are just a lose-lose too often, and it’s why for open enrollment, we are trying to make sure that people understand this is not the panacea to your healthcare problems.”

U.S. Reps. Jan Schakowsky (D-Ill.), Lloyd Doggett (D-Texas), Rosa DeLauro (D-Conn.), Ro Khanna (D-Calif.) were also involved in the call for MA oversight.

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