The Yearly Medicare Advantage Media Blitz

Richard Davis

The annual fall Medicare Advantage media blitz is in full swing. Private insurance companies are raking in billions of dollars on the backs of unwitting seniors who think they are getting a good deal but in fact are being robbed of not only benefits but money.

Here’s the quick rundown. In 2003 it was decided that the private insurance industry should share in the profits of the government’s Medicare program. It was a calculated political move to privatize Medicare and eventually turn it into an entirely private insurance product.

Keep in mind that Medicare’s administrative expenses run at about 2 percent while private insurance company administrative costs run as high as 20 percent or more.

Medicare is an efficient program and seniors who have been using what is now called traditional Medicare have been very satisfied with their coverage.

The creation of Medicare Advantage has been a cash cow for this country’s health insurers and they have been able to lure in more than half of all Medicare beneficiaries into their programs with promises of lower premiums and extra benefits such as gym memberships and limited hearing and dental coverage. Many Advantage programs have no charge for premiums so, on the surface, it seems like a no-brainer for people to switch to these plans.

But people need to dig a little deeper to understand why these Advantage plans are not what they seem. Under traditional Medicare a person can see any doctor in the U.S. who accepts Medicare, which is most providers. Advantage programs operate within networks and a provider has to be in network, in most cases, for a person to be covered. Traditional Medicare does not have gatekeepers requiring approval for procedures. Denials for coverage are common in Medicare Advantage programs.

There have been a number of lawsuits because of the private health care industry’s fraudulent and abusive behavior when it comes to Medicare Advantage. Consider this from the Physicians For A National Health Plan. “By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion ‍per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these— or other crucial aspects of Medicare and Medicaid—could be funded entirely by eliminating overcharges in the Medicare Advantage program.”

And it gets worse. According the Lever web site, as well as many other sources, “Humana is the most prominent example of how insurers have built a major cash cow out of systematically overbilling Medicare Advantage, the private Medicare program operated by private interests. These overpayments are symptomatic of a broader profit-driven policy agenda that seeks to completely privatize Medicare, one of the nation’s most popular social programs, and lock program recipients into subpar private insurance plans, even when they get sicker and need the best care possible. Medicare Advantage plans have higher claim denial rates and more prior authorization restrictions than traditional Medicare plans. Last year, regulators found that nearly one in five payment requests rejected by Medicare Advantage plans in 2018 were wrongfully denied, representing an estimated 1.5 million claims.”

A few politicians, such as Senator Bernie Sanders have been fighting against the juggernaut of Medicare Advantage while pushing for a Medicare for All program based on traditional Medicare. But it seems that the higher level power brokers are not listening because the insurance industry spends so much money buying politicians. Sadly, it is one of the best examples of what is wrong with this country’s political system and future generations of seniors will no longer have health insurance that is affordable or accessible unless we stop the move to privatize Medicare.

Comments | 1

  • How true!

    Thanks, Richard, for your annual reminder. The onslaught of ads is difficult to fight. Who wouldn’t want a premium-free insurance plan that provides eyesight and dental coverage, help on OTC products, gym memberships, and in some cases, offers to help with groceries and rent! Guess it’s great for folks who are healthy enough not to need specialist referrals, and live in areas where network providers are many and close-by, and who qualify for zero premiums. Lotsa luck.

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