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Democratic lawmakers have written a letter to the Centers for Medicare and Medicaid Services, criticizing the Trump administration for rushing the launch of Medicare's new provider directory tool.
Oregon Sens. Jeff Merkley and Ron Wyden said in their letter to CMS Administrator Dr. Mehmet Oz that the Medicare Advantage provider-directory tool is "riddled with erroneous, conflicting, and duplicative information."
Merkley and Wyden said issues involved with the launch of the directory could risk misleading millions of seniors as they compare plans, and could cause beneficiaries to incur medical bills they reasonably believed would be covered.
"The rollout was driven not by career CMS staff but by the acting administrator of DOGE currently embedded at CMS who is also leading the administration's broader national directory initiative," they wrote. "The directory tool – intended to help beneficiaries identify in-network providers – has been found to list some providers as both in-network and out-of-network or to display contradictory information across plan pages."
WHAT'S THE IMPACT
The lawmakers said in their letter that seniors are overwhelmed by numerous and complex plan choices, and often struggle to make informed decisions that would best suit their health needs in Medicare's insurance markets.
Most enrollees fail to select cheaper, more generous plans, and some may never switch from suboptimal coverage, they said. As a result, they claimed these beneficiaries often forgo substantial savings and do not reliably choose plans that maximize financial protection.
"In an MA enrollment process fraught with complexity that seniors and people with disabilities struggle to navigate, the sloppiness of CMS's new provider-directory tool makes these challenges only that much worse," they wrote.
While CMS' original stated intent was to build a full national directory that would simplify how seniors shop for coverage, the lawmakers accused the federal agency of rushing out a temporary MA-only version using data from one outside vendor, SunFire Matrix, a Medicare insurance market technology company.
"The accuracy of using data from one single vendor, and the data insurers volunteer, does not create a full overview of the landscape, leading to inaccuracies in the directory tool," according to the letter.
They added the tool has been found to list some providers as both in-network and out-of-network, or to display contradictory information across plan pages.
Wyden and Merkley also critiqued CMS for alerting Medicare Advantage Organizations (MAOs) that, due to potential errors in the directory, beneficiaries would be permitted to change plans within three months if provider-network misinformation influenced their selection. CMS did not, in their estimation, send a comparable notice to enrollees.
THE LARGER TREND
The senators are requesting several pieces of information from CMS by Nov. 17. Specifically, they want to know why and when the agency switched from its plan to build a larger national directory, and instead, moved to deploying a temporary MA-only tool.
They're also requesting to know the tool's budget, who authorized the accelerated timeline for its release, and why communications were not sent directly to beneficiaries.