Advocating for Medicare Advantage with Dawn Maroney of Alignment Health Plan

Summary

Becker’s Healthcare Podcast Summary
Episode: Advocating for Medicare Advantage with Don Maroney of Alignment Health Plan
Release Date: August 4, 2025

---

Introduction

In this episode of the Becker’s Healthcare Podcast, host Jacob Emerson engages in an insightful conversation with Don Maroney, the President of Alignment Health and CEO of Alignment Health Plan. With over 36 years of experience in the healthcare sector, particularly focusing on Medicare beneficiaries, Don brings a wealth of knowledge and a passionate perspective on the future of Medicare Advantage (MA).

---

Alignment Health Plan Overview

Don Maroney provides a comprehensive overview of Alignment Health Plan, highlighting its mission and reach.

Don Maroney [00:30]: “At Alignment, we are a Medicare Advantage prescription drug plan primarily serving five states: Arizona, California, Nevada, Texas, and North Carolina. We serve about 200,000 Medicare Advantage lives, transforming lives and being there when our members need us most.”

Alignment Health Plan emphasizes personalized and proactive care, aiming to deliver exceptional value and outcomes for seniors across its service areas.

---

Don Maroney’s Congressional Testimony

A significant portion of the discussion centers around Don’s recent testimony before the House Committee on Ways and Means and the Health and Oversight Subcommittees. This joint hearing focused on evaluating the past, present, and future of the Medicare Advantage program.

Don Maroney [02:06]: “It was an honor to represent Alignment Health before Congress. I wanted to spotlight what works and why it matters, sharing our vision to become more proactive, personal, and purpose-driven.”

Don expressed both excitement and nervousness about the opportunity to influence national policy, emphasizing the importance of advocating for policies that enhance the quality and value of MA programs.

---

Challenges in Medicare Advantage

The Medicare Advantage program has faced numerous challenges over the past few years, including regulatory changes and reimbursement trends. Don outlines some of the most pressing issues affecting the program.

Don Maroney [04:18]: “It has been the most challenging in the last 18 to 24 months, with regulatory policies and changes that everyone is concerned about.”

Key challenges include the implementation of prior authorizations and ensuring adequate rural care access, which are critical for maintaining the program’s integrity and accessibility.

---

Alignment Health’s Advocacy Priorities

Don outlines the primary advocacy goals Alignment Health is pursuing to address the challenges facing Medicare Advantage.

1. Hospital Parity

Ensuring that Medicare Advantage plans receive the same consideration as Medicare fee-for-service contracts when partnering with hospitals.

Don Maroney [04:50]: “If a hospital is accepting Medicare fee-for-service, they should automatically accept Medicare Advantage contracts. This would foster competition and improve access, especially in rural markets.”

This policy aims to level the playing field, allowing high-performing MA plans like Alignment to compete fairly and expand their reach.

2. Choice for Dual Eligible Beneficiaries

Advocating against policies that limit the choices of dual eligible beneficiaries by forcing enrollment into exclusively aligned plans.

Don Maroney [06:15]: “Seniors deserve a choice, and they should absolutely still have a plan like Alignment available to them with continuous open enrollment.”

Maintaining choice ensures that beneficiaries can select plans that best meet their individual healthcare needs.

---

Alignment Health’s Star Ratings

Don proudly highlights Alignment Health Plan’s exceptional performance in Medicare Advantage star ratings, underscoring the company’s commitment to quality care.

Don Maroney [07:48]: “100% of our members across all of our states are in a four-star or greater. We are one of the seven Medicare Advantage plans nationwide that qualify for a five-star plan.”

These high ratings reflect Alignment’s dedication to delivering superior healthcare services and outcomes for its members.

---

Current Political Climate in Washington

Discussing the political landscape, Don shares his perspective on how lawmakers are currently approaching the Medicare Advantage program.

Don Maroney [08:43]: “I believe both sides really care about Medicare Advantage. It’s not about restricting the program but refining and strengthening it to ensure competition, choice, and value.”

Under the new administration, there is a focus on enhancing the program without imposing undue restrictions, aiming to support smaller organizations and promote sustainable, value-driven care models.

---

Final Thoughts and Advice

As the conversation concludes, Don offers valuable advice to other Medicare leaders, emphasizing the importance of consumer-centric approaches and supporting healthcare providers.

Don Maroney [10:28]: “Put the senior first, support the doctors caring for them, and leverage technology like AI to assist rather than replace the human touch. Focus on ensuring seniors are independent, mobile, and have peace of mind.”

Don underscores that prioritizing the needs of seniors and fostering strong relationships with healthcare providers are crucial for the sustained success of Medicare Advantage programs.

---

Conclusion

Don Maroney’s insights offer a compelling look into the current state and future direction of Medicare Advantage. His dedication to advocating for seniors, enhancing program quality, and fostering competitive and equitable healthcare environments positions Alignment Health Plan as a leader in the Medicare Advantage landscape. For more in-depth discussions and industry analysis, listeners are encouraged to explore additional episodes of the Becker’s Healthcare Podcast.

---

For more information and to listen to additional episodes, visit Beckershospitalreview.com.

Transcript

[A]

Hello everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Don Maroney, who is the president of Alignment Health and CEO of Alignment Health Plan. Don, thank you so much for taking the time to be with me on the podcast today.

[B]

You're welcome.

[A]

And Don, before we dive into everything, we want to talk with you about a pretty big issue and something really impactful that you did last week. Can you tell us a little bit more about yourself and for our listeners who might not be familiar what Alignment Health does and who you serve?

[B]

Absolutely. Well, I actually have been in the healthcare space primarily working with Medicare beneficiaries for about 36 plus years and with alignment for approximately 11 of those years, I've had the privilege of leading the organization that is redefining how we serve seniors. And at Alignment, we are a Medicare Advantage prescription drug plan primarily and serving in five states and in Arizona, California, Nevada, Texas, North Carolina. Super excited about that. We're continuing to grow. We serve about 200,000 Medicare Advantage lives and it really is about transforming lives and being there when they need us most. And so super excited about that.

[A]

Well, appreciate you taking the time to sit down with us, Dawn. And like you mentioned, you've been in the Medicare space for a long time and you got to share your expertise. Learning last week, July 22, as a witness in front of the House Committee on on Ways and Means and the Health and Oversight Subcommittees in a joint hearing about the past lessons, current insights and future opportunities within the Medicare Advantage program. Alongside you we heard from academics and, and from other Medicare Advantage insurers as well. So talk to us about what this experience was like for you. How, how did it feel to testify before Congress on, on such a high stakes issue like Medicare Advantage and, and what mot personally and professionally to take something like this on?

[B]

Well, I love this program. I love working with seniors and Medicare Advantage, you know, since the, the very beginning, as many years as I can go back, I think it's 1989 specifically and it was such an honor to represent Alignment Health before Congress specifically, as you stated, the House Ways and Means and Oversight subcommittees with you know, Chairman Buchanan, Oversight Subcommittee Chairman Schweikart, and then of course the rank members who as well as the full committee, which was exciting. It was a full House including the overall chair, Mr. Smith. So very, very exciting on that. It was very, I was a little bit nervous because I wanted to make sure when we talk about Medicare Advantage and the program, when done right, how it Saves lives, saves money. I was there to, you know, of course, spotlight what works and why it matters. This was a powerful opportunity to share our vision and how we can become more proactive, more personal and purpose driven. It did give Alignment the national platform to push policies that we believe that will reward the right kind of care, care that delivers better outcomes and real value. Being in healthcare for the past several decades, I wanted why he joined Alignment. I wanted to become something, you know, just more than just providing just insurance, but really advocating for seniors with more compassion, accountable health system. And it's not just, you know, it's isn't just a privilege, it's a responsibility that I take seriously. And it was such an honor to be there.

[A]

Absolutely. That's, that's really great to hear and how you advocated on behalf of your members and of course, the wider program. Don, it's certainly no secret that the MA program has faced a lot of challenges these, these last few years. And so I wonder, you know, what were some of the most urgent changes that Alignment was advocating for and that you want to see from lawmakers when it comes to the future of Medicare Advantage, especially in light of some of the more recent regulatory and reimbursement trends we've seen?

[B]

Yeah, it, it is, it has been, I think it's been probably the most challenging in the last, you know, 18 to 24 months. Would say more and more with some of the reg policies as well as some of the changes that, you know, everybody wants. And for us, you know, our positioning, there's, you know, we believe that there's a couple of priorities that can address some of the concerns of the congressional leadership that, you know, they talked about prior authorization, they talked about rural care and making sure that, you know, as this plan has more than 50% beneficiaries that are in the environment that are, and people are electing to choose that. How do you get plans like this even in more rural counties? And so one I would put out, really hospital parity. Too many large hospital systems or even smaller community hospital systems in rural counties or in counties decline to contract with higher performing, smaller MA plans such as ours. This undermines access and competition, especially in those markets. We believe that if a policy were generated to push where every hospital, if they're accepting Medicare fee for service, that they should automatically accept Medicare Advantage contracts. Now, there can be a baseline of those contracts. For example, at minimum, if there's not a value value based care agreement, then we would default to a Medicare fee for service contract, meaning we'd pay 100% what Medicare does and this would give some flexibility and some competition in those markets, but it should be hospital parity across the board. The other area which we're seeing, and as you're, you know, we're seeing some other changes in other sectors, specifically on Medicaid. We're seeing, you know, that the force and the push in the last several years is to push Medicare Advantage members that have dual eligible status to be enrolled in an exclusively aligned plan. And this is not just California, but there are multiple states that are pushing this agenda where they automatically default to those plans. I think, you know, those programs absolutely should be there, but they should also stand alone and they should still have competition. The Medicare Advantage that seniors should not be limited on their choice and selection of what they're choosing. Especially when you look at an organization like ours. 100% of our members across all of our states are in a four star or greater. And I talked about this last week as well that we are one of, I said nine, but we're actually one of seven Medicare Advantage plans across the country that qualify for a five star plan. And we believe continuing on, we should hope to see that we'll be consistent in that category as we look at this fall and open enrollment. But dual eligible beneficiaries which are commonly have multiple chronic conditions, have lower incomes, they have, you know, less flexibility of what to choose if they're defaulted into a plan. I don't think that's right. I think these seniors deserve a choice and that they should, they should absolutely still have a plan like an alignment that will be available to them and have the continuous open enrollment that they do today.

[A]

Absolutely. And I'm really glad you, you pointed out that tidbit about your, your star rating success because it's true. You really alignment is one of the most highest rated Medicare Advantage plans consistently year after year. And you're one of just a handful of plans around the country that has achieved that. So it's so great to hear, you know, about how you're advocating for, for more choice and, and supporting rural healthcare access moving forward for your members and for the wider population. I also want to ask you, you know, we, we've heard so much from both sides of the AIs about, about Medicare Advantage changes that should be made. So what was your sense of what's going on in Washington right now? How do you think lawmakers are currently thinking about the Medicare Advantage program? Certainly now that we're under a new administration, are you feeling that they're leaning more toward Reform, more restriction, support for what you're talking about. What do you what's your sense of what's happening right now?

[B]

DAWN well, first and foremost, I have respect for both sides and I actually do believe both sides really care. When I think about Chairman and Schweikart and Doggett and Sewell, they understand the value of Medicare Advantage, what it brings, and they really do care about the Medicare beneficiaries. This isn't really about restricting the program. It's refining and strengthening it. And how do you have organizations that may be smaller than the larger organizations that are out there in the environment, have be a part of that competition without having restrictions around it. And it's giving seniors choice, driving quality through that competition and value. And, you know, and how you stretch every healthcare dollar. And that's what we do. We look at a proactive, integrated approach to care. We have a high touch care model, which is different. We believe that sometimes you may invest higher dollars in the first year of that enrollment where you're actually losing money. But in, in the years to come, if you really do put your patience before profit, then you shall profit. So it but it does take time and it takes an investment. And I felt the listening of what we were trying to do. But how do you reform, you know, reform the program without restricting it? And there was a lot of dialogue and a lot of discussion, and our goal is just to make sure that we have a seat at the table to help them refine those policies.

[A]

Sure. Yeah, that makes, that makes a lot of sense. Before we go, Don, what else are we missing? Are there any final thoughts or final tidbits of advice that you want to offer the other Medicare leaders listening in?

[B]

I think they're first of all, you have to really care about this consumer and make sure that they are the absolute priority. We look at it as, you know, you put the senior first, but how do you support the doctor that is taking care of that senior? And that doctor doesn't always have to work for, for you. We have 25% of our employees that are clinicians, but they don't always have to work with us and work for us. I mean, they have to work with us, I should say. They should be aligned and, you know, enable technology. There's a lot of discussion about AI. We look at AI as how do you use AI from an assistant standpoint? And then how do you have a serving heart? But this consumer really wants to make sure that they are independent, mobile and have peace of mind in that process. And if you think about those pieces. No matter if you're somebody that's starting up or if you're somebody that's been in business for quite some time, if you put them at the center of your focus, then you should be able to do Medicare Advantage right and win in this business for years to come.

[A]

Fantastic. Well, Don, I really appreciate you taking the time to sit down with us and for sharing your insights about how you and Alignment are really advocating and pushing for the continued evolution, refinement, and improvement of such an important program. We really appreciate it.

[B]

Thank you so much.

[A]

And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.