Lawmakers Lobby for Payment and Policy Stability in Medicare Advantage
The group of senators called for payment and policy stability in Medicare Advantage in the wake of new marketing, competition, and prior authorization standards.
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- A bipartisan group of United States Senators has urged CMS to ensure payment and policy stability in Medicare Advantage as the agency considers program updates for 2025.
The letter to CMS Administrator Chiquita Brooks-LaSure was led by Sens. Catherine Cortez Masto (D-NV), Tim Scott (R-SC), Gary Peters (D-MI), and Shelley Moore Capito (R-WV). An additional 57 senators co-signed the letter.
The senators highlighted the affordability of Medicare Advantage. They noted that nearly 75 percent of seniors in a plan with Part D prescription drug coverage paid no additional premium in 2023. Medicare Advantage beneficiaries are more likely to have annual salaries of under $20,000 compared to those in traditional Medicare; thus, ensuring access to supplemental benefits and out-of-pocket protections in Medicare Advantage is essential, the letter stated.
The letter also praised the Medicare Advantage program for serving diverse populations, allowing health plans to address health-related social needs, providing access to telehealth and home healthcare services, and prioritizing primary care.
“We ask that the Administration consider the ongoing implementation of program reforms finalized last year and provide stability for the Medicare Advantage program in 2025,” the senators wrote. “We look forward to partnering with you to ensure that, through Medicare Advantage, tens of millions of older and disabled Americans have access to comprehensive, affordable Medicare coverage choices.”
Better Medicare Alliance (BMA) commended the lawmakers for supporting Medicare Advantage, noting that the message aligns with a previous stakeholder letter sent to CMS and signed by BMA and 65 other organizations.
The BMA letter called for stability in the Medicare Advantage program and called on CMS to follow through with their proposals to improve health equity, advance data collection and evaluation of supplemental benefits, establish marketing guidelines, and boost access to mental and behavioral healthcare.
“We further call on health plans and other stakeholders to strengthen and improve Medicare Advantage as a reliable, equitable, and high-quality healthcare coverage option for millions of seniors and people living with disabilities,” the stakeholder groups wrote.
The urges for Medicare Advantage stability come as CMS attempts to reign in some of the issues happening in the private program.
For example, in the 2024 Medicare Advantage and Part D Final Rule, the agency released policies to increase marketing oversight. New for 2024, plans cannot deploy ads that use Medicare logos or other words and imagery in confusing or misleading ways. CMS also reinstated protections that prevent predatory behavior and finalized changes that strengthen plans’ role in monitoring agent and broker activity.
In November 2023, CMS aimed to address anti-competitive activity in the program by proposing a national agent/broker fixed compensation of $632. A fixed rate would help eliminate payment variability and improve the predictability of compensation for agents and brokers.
Most recently, CMS finalized prior authorization requirements for most public payers—including Medicare Advantage organizations—to streamline the process and reduce patient care disruptions. Plans must send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests starting in 2026. In addition, payers must provide a specific reason when they deny prior authorization requests.
Prior authorization is a frequent issue in Medicare Advantage plans. In 2021 alone, plans denied 2 million prior authorization requests.
