We are inundated with countless TV commercials by private insurance companies saying their Medicare Advantage (MA) plans are so much better and more affordable than traditional Medicare.
A Kaiser Family Foundation investigation found that TV ads for MA plans “comprised more than 85% of all airings for the open enrollment period for 2023.” The ads “often showed images of a government-issued Medicare card or urged viewers to call a ‘Medicare’ hotline other than the official 1-800-Medicare hotline.”
Meanwhile, on Oct. 18, the mainstream media paid little or no attention to a U.S. Senate Finance Committee hearing on MA plans. Almost a year before, in November 2022, the Finance Committee issued a report entitled “Deceptive Marketing Practices Flourish in Medicare Advantage.”
“Every fall, Medicare eligible consumers are bombarded with mailers, TV ads and phone calls rife with misleading and pernicious content,” Cobi Blumenfeld-Ganz, co-founder and CEO of Chapter, a Medicare advisory firm, told the Finance Committee during an oral testimony this year. “The bad actors are typically not local brokers who live in each community, rather, they’re lead generators operating as marketing middlemen who traffic in scare tactics, imitate government agencies and inaccurately advertise plan benefits.”
Medicare Advantage is a privatized version of the federal program created in 2003 by President George W. Bush. It is a scam where the government pays insurance companies to provide coverage.
In his opening statement, Senate Finance Committee chair Ron Wyden (D-Oregon), said insurers’ marketing expenses cost taxpayers $6 billion. Ryan Cooper reports in The American Prospect that “the government spends a truly stupendous amount of money, time and effort cooking up ultra-complicated systems and regulations to keep these insurance companies from ripping off the program. The Centers for Medicare & Medicaid Services (CMS) keeps a continually updated database with the health characteristics of every single one of the 61 million Medicare enrollees, which is used to determine how much insurers are paid — yet the companies are always one step ahead.”
Sen. Maggie Hassan (D-NH) shared a story of a constituent who cares for her 26-year-old son with a developmental disability who is eligible for Medicare. An MA agent called the son’s cell phone and talked him into switching to an inadequate plan in a five-minute phone conversation.
Sen. Michael Bennet (D-CO) said he was hearing from hospitals across the state about MA denials and delays, including one hospital that had every claim from one MA plan denied.
Now rightwingers, such as Sens. Tom Cotton (R-AK) and Steve Daines (R-MT), are accusing Joe Biden of favoring Medicare cuts. This is a clever lie. They are angry at the Biden administration’s moves to rein in the rampant fraud and abuse in MA plans. For example, the CMS issued a rule increasing auditing of MA plans and rejected some 300 MA television ads due to misleading messages.
Unfortunately, the administration is dealing with a huge crime spree. The New York Times reports that most MA providers have been accused of fraud in court, and all but two have been cited for overbilling by the CMS inspector general.
Becker’s Hospital Review outlines how many hospitals and health systems are dropping MA plans due to excessive denial rates, slow payments and billing fraud.
A report published this month by Physicians for a National Health Program (PNHP) estimates that MA plans are overcharging taxpayers by up to $140 billion per year. That money could be used to completely eliminate Medicare Part B premiums or fully fund Medicare’s prescription drug program.
MAs have become quite popular because they cover some things not covered by traditional Medicare, such as vision and hearing. They more than compensate for the extra cost by ruthlessly “managing” nominally covered services, by targeting their marketing to relatively healthy seniors and by overcharging the government. At the end of this year, more than half of all of the people enrolled in Medicare will be in Medicare Advantage.
MA plans are more profitable than other health industry products. After Republican attacks and intense industry lobbying, the Biden administration agreed to phase in its rule changes over a three-year period.
We need to not only fight the creeping privatization but institute Expanded and Improved Medicare for All, which would cover everyone — with dental, vision and hearing care. No premiums, deductibles or coinsurance.
This opinion does not necessarily reflect the views of Boulder Weekly.
