00:00Thank you, Mr. Chairman. Thanks to all the witnesses for your written and your verbal testimony and appreciate this opportunity to wave on. I'm not normally on this committee, but obviously this is an important topic, so it's a good opportunity.
00:12But I'm going to narrow, you obviously talked a lot about a number of things dealing with Medicare Advantage, but I'm going to focus on one thing, and I'll get to that after I've got a couple of comments here.
00:22I come from the Central Coast of California, 19th Congressional District, and obviously it being the most beautiful Congressional District in the nation, if I may say so in my humble opinion, actually biased opinion, a lot of people want to live there.
00:36A lot of people retire there, so Medicare is the number one issue, and unfortunately it has a lot to do with the reimbursement rates, to be honest with you.
00:44That's why I've been focused on reforming payments to doctors and clinicians under Medicare Part B.
00:49However, we know that traditional Medicare is not the only place where seniors and other beneficiaries receive their care.
00:56In my district, and as of last year, 33.3 percent of Medicare-eligible beneficiaries were enrolled in Medicare Advantage.
01:04Statewide, in California, more than half of those who live there choose Medicare Advantage, consistent with the national trends.
01:12But what's troubling is the advent of these things called ghost networks, and that's going to be the crux of my questions.
01:18Unlike traditional Medicare, Advantage operates more like a typical commercial health plan, meaning patients have a private insurance company and seek care from providers in their networks.
01:30And like those of us who have commercial insurance, going out of network will cost you.
01:36For seniors on a fixed income and the disabled, this simply isn't an option.
01:40Patients rely on provider directories from Medicare Advantage insurance plans to find in-network providers.
01:46However, many insurance insurers fail to update these directories, creating ghost networks of providers who are listed as options for care despite no longer practicing, no longer accepting patients, and are not part of the plan's network.
02:04The confusion that can arise from ghost networks can result in delays in care, inappropriate treatment, and unnecessary costs for patients who unknowingly visit out-of-network providers.
02:17Dr. Miller, in your testimony, you explicitly mentioned ghost networks, and I appreciate that.
02:22You argued that directory reform would bring Medicare Advantage plans closer to the private market.
02:30Can you elaborate and expand on that, please?
02:32I admit I'm a little biased because as a medical student, I incurred an $8,000 out-of-network medical bill because the provider directory was not up-to-date.
02:43So I have personal experience in that being a problem.
02:46The ACA Exchange Marketplace actually has a function where the beneficiary or the consumer can put in their doctor, hospitals, drugs, and see if the plan covers it.
02:59You can't actually do that in the Medicare plan finder.
03:03And if you do that, it would force the entire Medicare Advantage industry to make sure that provider directories are up-to-date and create a routine process which can then be used to audit the plans
03:16and implement penalties as appropriate for not having an up-to-date directory.
03:21I mean, you can't get access to care if your doctor is not in the network and you didn't know that.
03:28You end up paying for it.
03:30And when you're a Medicare beneficiary and the average income for half of them is under $50,000 a year, that's expensive.
03:37So I think that updating the plan finder to ensure that provider directories are up-to-date and so that when a Medicare beneficiary selects Medicare Advantage,
03:46they have an unbiased source of where they can get that information is something that we have to do.
03:52Yeah, thank you.
03:52Look, one of the reasons I like being on the Ways and Means Committee is there's members on both sides of the aisle that actually want to get stuff done.
03:59I've introduced a bill with Dr. Murphy, Mr. Schneider, Mr. Fitzpatrick, called the Requiring Enhanced and Accurate Lists, or REAL, Health Providers Act.
04:08The bill would require Medicare Advantage insurance plans to update their provider directories annually
04:13and ensure patients aren't left on the hook for out-of-pocket expenses like the one you described.
04:19You got an opinion on how a bill like REAL health providers that requires plans to update their directories annually,
04:27how that would impact Medicare Advantage?
04:29I mean, I haven't read the text.
04:31I'll have to look it up, but on the principle, it makes sense.
04:34I would say that it has to be integrated into the plan finder so that way the consumer can make sure that they see it
04:40or the person helping the consumer pick a plan.
04:42And I would say in addition to that, the plan finder should allow the beneficiary to compare fee-for-service, Medigap,
04:50and a standalone Part D plan with MA and see what their out-of-pocket premiums are
04:56and see what the trade-off of having lower out-of-pocket costs for premiums versus accepting a network.
05:03Because right now the beneficiary can't figure that out from the plan finder.
05:07I appreciate that and look forward to working with you and all of you on fixing this.
