Spread the Word: Medicare Advantage is NOT Medicare. It's a Scam.
The ultimate goal here - besides the profit motive - is to migrate so many Americans away from traditional Medicare that republican lawmakers can then seem justified in putting a knife in Medicare.
A few months ago, I was having some work done on my house.
The professional completing the work is someone I have known literally my whole life. He is well-spoken, honest, efficient, intelligent, and is as progressive as I am, which makes our occasional political conversations comfortable.
This particular day, though, our conversation about health insurance and Medicare started to get tense.
I could see my friend’s expression morphing from one of affable interest into genuine annoyance, so I quickly changed the subject.
What was it I said that made him so agitated?
I simply informed him the Medicare Advantage plan he was on is not Medicare.
“But ‘Medicare’ is in the name,” he puzzled.
“Yes,” I said. “That’s the problem.”
Since its passage in 1965, Medicare has been on the list of items at which the republican party, and even some members of the Democratic party, have been steadily chipping away.
The George W. Bush administration landed a major blow to it in 2003 with the passage of the “Medicare Modernization Act” that created something called “Medicare Advantage” under Medicare’s Part-C provision.
The following year risk-adjusted large-batch payments offering Advantage plans started to make insurance companies even more insanely rich.
But the “Medicare” label is a ruse.
Medicare “Advantage” isn’t Medicare.
It’s private for-profit health insurance that fools recipients like my friend and millions like him into believing they are enrolled in Medicare.
As progressive talk show host and author of The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich, Thom Hartmann, wrote:
“Medicare Advantage is a massive, trillion-dollar rip-off, of the federal government and of taxpayers, and of many of the people buying the so-called Advantage plans.
“It’s also one of the most effective ways that insurance companies could try to kill Medicare For All, since about a third of all people who think they’re on Medicare are actually on these privatized plans instead.”
In the twilight of the Trump administration, we saw the rise of a third-party-run program called Medicare Direct Contracting (DC) that permits commercial insurers and other for-profit companies to “manage” care for seniors enrolled in traditional Medicare.
Under this system, instead of having the freedom to choose healthcare providers as they are with traditional Medicare, older Medicare-enrolled Americans are automatically enrolled into a “Direct Contracting Entity” (DCE) without their knowledge or consent.
If any primary care physician happens to be affiliated with a particular DCE, his or her patients may be “auto-aligned” with that DCE.
We would like to assume this program was eliminated or at least reformed when Trump left the White House.
But it wasn’t.
But even though there has been no vote in Congress, there has been movement to address it.
Late last year, Washington Rep. Pramila Jayapal joined physicians and advocates in urging the Biden administration to immediately end DCE.
Jayapal and Physicians for a National Health Program (PNHP) president, Dr. Susan Rogers, explained in an op-ed for The Hill:
“Instead of paying doctors and hospitals directly for seniors’ care, Medicare gives these middlemen (called Direct Contracting Entities, or DCEs) a monthly payment to cover a defined portion of each seniors’ medical expenses. DCEs are then allowed to keep what they don’t pay for in health services, a dangerous financial incentive to restrict and ration seniors’ care.”
They added:
“This should be a huge red flag for taxpayers and anyone concerned about funding Medicare for future generations. While traditional Medicare spends an impressive 98% of its budget on patient care, Direct Contracting Entities only spend 60% of our tax dollars on patient care — keeping up to 40% of revenues for their own profit and overhead.
“Since Direct Contracting is a pilot program, it can and should be stopped in its tracks by the Biden administration while we have the chance. After our experience with commercial Medicare Advantage plans, we already know that inserting a profit-seeking middleman into Medicare ends up costing taxpayers more, with fewer choices and worse outcomes for seniors.”
The good news is, others are starting to catch on.
As reported recently in Axios, according to Centers for Medicare & Medicaid Services (CMS), “Complaints about aggressive marketing tactics and other issues connected with private Medicare plans are surging.”
It adds:
“While enrollment in Medicare Advantage has risen every year since 2007, according to a KFF report, so, too, have questions about the quality of care and whether the program is becoming a haven for high-pressure sales tactics and scammers.”
Senate Finance Chair Ron Wyden (D-Ore.) has initiated an investigation in which he is requesting information from 15 state regulatory agencies about false or misleading marketing.
House Ways and Means Health Subcommittee Chair Lloyd Doggett (D-Texas) is on it as well. He and 30 additional other Democratic House members are recommending changes to private Medicare plans that include addressing aggressive and misleading marketing tactics.
Writing to CMS administrator Chiquita Brooks-LaSure, House members explained:
“Aggressive sales tactics have left vulnerable seniors and people with disabilities susceptible to being misled and unwillingly steered into Medicare Advantage plans.”
Sen. Wyden stated:
“I’ve been concerned about the growing number of complaints that have been reported. I’ve really come to the conclusion that not all MA [Medicare Advantage] is created equal. There’s some that is quite good and there are some ones that we have some questions about, and that’s what we’re doing.”
The problem isn’t just that so many assume they’re on Medicare when they are in fact on private insurance.
The bigger problem lies in the fact that Medicare Advantage providers submit bills to the federal government based on customers’ aggregate risk scores, and are paid a considerable lump sum for all their customers.
So, the higher a risk score, the larger the payment.
For-profit insurance companies raise their risk scores without raising their expenses by making customers appear sicker than they are.
The ultimate goal here — besides the profit motive — is to migrate so many Americans away from traditional Medicare that republican lawmakers can then seem justified in putting a knife in Medicare permanently.
Let your friends, family, co-workers, and neighbors around Medicare age know Medicare Advantage IS NOT MEDICARE.
They will think it is because, as my friend argued, “Medicare is in the title.”
Then when they are refused care or given the runaround common when dealing with private insurance companies, they will target their ire at that “Socialist Medicare.”
That is precisely what republicans want.