Sens. Brown, Blumenthal, Rep. Delauro Introduce Plan to Prevent Medicare Recipients’ Doctors from Being Dropped By Network After Coverage Begins

Following New GAO Report Uncovering Deficiencies in How CMS Ensures Adequate Medicare Advantage Networks, Brown, Blumenthal, and DeLauro Introduce Legislation to Improve Access for Seniors

WASHINGTON, D.C. – U.S. Sens. Sherrod Brown (D-OH) and Richard Blumenthal (D-CT), along with U.S. Rep. Rosa DeLauro (D-CT-03), introduced a plan to prevent Medicare enrollees’ doctors from being dropped by networks once coverage begins. The Medicare Advantage Bill of Rights Act would ensure that enrollees know what providers will be covered for the entire year under their plan, rather than just at enrollment time.

“Seniors and other Medicare recipients deserve the peace of mind that they’ll be able to receive care from their trusted doctors year round. But in recent years, we’ve heard too many reports of doctors being dropped from a patient’s network,” said Brown. “To ensure that Medicare Advantage plans work for doctors and beneficiaries, I’m reintroducing legislation that would ensure MA plans cannot drop providers from their network in the middle of a plan year without cause. It would also improve network adequacy protections in MA plans, and ensure consistency for both beneficiaries and health care providers on an annual basis.”

“Seniors deserve to know that when health issues arise, they will always be able to turn to their own trusted physician,” said Blumenthal. “This legislation ensures that the millions of seniors who rely on Medicare Advantage will not be faced with the unnecessary burden of finding a new doctor only because an insurer is more concerned with its bottom line than it is with the care people receive. We cannot allow insurers like United Healthcare Group to drop thousands of qualified doctors from their plans mid-year, without explanation, and force Americans to lose coverage for care from providers they know and trust.”

“Today, Medicare Advantage patients can have their doctors dropped by the plans during the middle of the plan year, making it difficult to ensure uninterrupted, quality health care,” said DeLauro. “My bill, the Medicare Advantage Participant Bill of Rights, will ensure that we hold insurance companies accountable, while putting our seniors first. We cannot allow our doctor-patient relationships to become interrupted during treatment without cause, much like we experienced in Connecticut with United HealthCare. I will continue to stand up and fight for our seniors to receive the highest quality care and ensure that they can live their lives with the economic and medical security they need.”

Under current law, Medicare Advantage (MA) plans can drop providers without cause during the year after seniors have already selected their plans – leaving many seniors without access to their preferred doctors.

The legislation would address this by:

  • Requiring MA plans to finalize their provider networks 60 days before the annual open enrollment period begins to ensure that enrollees know what providers will be covered before they enroll in an MA plan;
  • Prohibiting plans from dropping doctors without cause during the middle of a coverage year, to ensure that enrollees do not lose access to their doctors mid-year;
  • Enhancing transparency by requiring MA plans to disclose the reasons for dropping providers;
  • Defining the minimum information requirements for MA enrollee notification letters that alert beneficiaries to changes to their networks ahead of reenrolling;
  • Directing the Centers for Medicare and Medicaid Services (CMS) to redesign the tool that enables patients to compare plans; and
  • Improving network adequacy standards for MA plans and requiring CMS to review MA networks on a more regular basis.

In September, a Government Accountability Office (GAO) report found that CMS must take additional action to ensure MA participants have access an appropriate number of doctors, known as an adequate provider network. CMS defines an adequate provider network as having a minimum number of providers, and a certain travel time and distance to those providers. The Medicare Advantage Bill of Rights will address many of the issues raised in the GAO report, which can be read in its entirety here.