Right now, Big Insurance is descending on Capitol Hill with millions of dollars and an army of lobbyists and ad campaigns to spread disinformation about Medicare Advantage, or as we like to call it Medicare (Dis)Advantage. It is part of the industry's annual push to drum up congressional support for a program that uses taxpayers' dollars to line the pockets of corporate insurance executives and increase their already sky-high profits—profits that are made off of the backs of taxpayers when insurance companies fraudulently make their enrollees look sicker than they really are to get more money from the government—up to $156 billion per year.

But here is the truth, plain and simple: Medicare Advantage is neither Medicare nor an advantage. It is a scam promoted by large insurance companies like UnitedHealth hiding behind the name of a trusted program.


The trouble for Big Insurance is that more and more lawmakers are coming to this conclusion. And as support for Medicare Advantage on Capitol Hill begins to decrease and demands for reform become louder, Big Insurance, in a desperate attempt to stop the bleeding, has doubled down on its disinformation campaign.

At a disadvantage?
Advocates hold signs during a news conference on Medicare Advantage plans in front of the U.S. Capitol on July 25, in Washington, DC.
ALEX WONG/GETTY IMAGES
Since sunlight is the greatest disinfectant, let's look at the claims these corporations are making to Congress.

First off, the industry claims that Medicare Advantage plans reduce costs. But this is simply not true. Unfortunately, Medicare Advantage has never saved the taxpayers money. In fact, the opposite is true. Spending per beneficiary is growing faster in Medicare Advantage than in traditional Medicare with no increases in quality of care.



hile Big Insurance touts the coverage Medicare Advantage plans provide, the reality is Medicare Advantage plans often provide worse coverage than traditional Medicare.In fact, recent data has shown that the worst five percent of Medicare Advantage plans are responsible for 10,000 preventable deaths every single year. And a recent study published in the Journal of Clinical Oncology found that people with Medicare Advantage plans are significantly more likely to die in the month following surgery for stomach, pancreatic, or liver cancer compared to people in traditional Medicare.



Another important characteristic of Medicare Advantage plans is their aggressive use of tools to delay and deny care such as prior authorization, which is seldom used in traditional Medicare, and rarely for services like physician-administered cancer treatments (no one wants chemotherapy if they don't need it). Studies have shown that 99 percent of Medicare Advantage plans require prior authorization for prescribed treatments. If your doctor says you need care, that should be the end of it, not the beginning of a series of expensive hoops to jump through because insurers want to increase profits.

It's unconscionable for Medicare Advantage plans to delay care through unnecessary prior authorization red tape and then still charge high out-of-pocket costs after a doctor has confirmed a patient needs physician-provided therapies.

Medicare Advantage plans also drive health inequalities, contrary to Big Insurance claims. These private insurance plans target people of color to enroll in Medicare Advantage plans that offer inferior care. Unfortunately, the shiny but paper-thin benefits Advantage plans use to reel in unsuspecting seniors and people with disabilities attract patients of color and low-income patients because they offer small upfront cost savings. Then the private insurance plans pull a bait and switch and delay and deny care for their mostly BIPOC patient pools thus worsening health disparities.


And the industry's biggest and boldest piece of disinformation is that Medicare Advantage plans will be forced to cut benefits if the government stops massive overpayments that have been padding corporate profits for decades.

This is wholly false. And you want to know how we know? Because we have reduced overpayments before.

After the Affordable Care Act reduced overpayments, there were no decreases in access to care or increases in costs for Medicare Advantage beneficiaries. Of course, curbing overpayments would, however, rein in excessive profit margins made on the backs of taxpayers, which have allowed private Medicare Advantage insurers to more than double their profit margins per enrollee.

Insurance companies don't want you to know that by stopping these overpayments, we could fully pay for massive improvements to Medicare including expanding benefits to include dental, vision, and hearing care, establishing a low cap on out-of-pocket spending for everyone in Medicare, or lowering the Medicare age. In fact, in a memo, now removed from the internet, commissioned by America's Health Insurance Plans (AHIP), they confirm that if dental, vision, and hearing benefits were added to Medicare with no additional funds given to Medicare Advantage companies, the companies would still have rebate dollars left over after paying for their members' care.


Hence, the disinformation campaign.

And this disinformation campaign is not limited to the halls of Congress. Talk to seniors in Seattle or Lake Forest Park or Shoreline–or any community, for that matter–and they will tell you about their struggles with Medicare Advantage, whether it be the relentless and misleading advertising campaigns or how hard they make it to get care.

Sensible reforms can fix many of the problems of Medicare (Dis)Advantage, bring better care to our seniors and people with disabilities, and decrease health inequities. But Big Insurance has fought them at every turn.

It's time for the disinformation to stop and the truth to come out. And it's time for Congress and the administration to implement sensible reforms to the program. Seniors in this country deserve a comprehensive, sustainable Medicare program that serves patients' needs, not corporate profits.


Jayapal represents Washington's 7th congressional district in the United States House of Representative and Potter is former VP, corporate communications, Cigna, and publisher of HEALTH CARE un-covered.

The views expressed in this article are the writers' own.


LINK; https://www.newsweek.com/truth...information-campaign



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The too-good-to-be-true claims (putting money back in your SS payment??) made by their advertisers are enough to turn me off from any Medicare Advantage plans.

My dad has the Humana program, and without it the basic medicare programs are weak, you have to add all levels to get even close to the Advantage plans benefits.

He gets unlimited trips to medical related visits on Uber, a god send since he's too far for us to drive up and take him to appointments, there are benefits for all kinds of things that include prescriptions at much lower cost or zero compared to the governments medicare programs.

The fact is that the governments programs are sorely lacking and well behind in funding the costs really associated with care for people on medicare.

My neighbor is on one of the Advantage plans and said it's better than the last corporate plan he had, even includes membership in a local gym to work out and remain healthy.

Article reads like a "hate insurance" plan, and if the government covered the things the advantage plans have they'd screw it up and you'd have to fight to get care.

In no cases for my dad has he had to fight to get coverage paid or services rendered.

My sister and I basically monitor my moms plan. It is a Medicare Advantage plan. I have heard horror stories. She pays next to nothing for all the stuff she requires. I keep waiting for the proverbial shoe to drop but so far so good.

quote:

Article reads like a "hate insurance" plan, and if the government covered the things the advantage plans have they'd screw it up and you'd have to fight to get care

^^^^^^^^^^
The local hospital and all the physicians opted out of the Medicare Advantage plan. They informed patients with a sign at the clinics and at the hospitals. They offered choices of new hospital and doctors fifty miles away. It is all about the money.

My mother was on Humana Gold "Advantage" Plan. She had a major stroke January 2023. There was NOTHING "advantageous" about her Humana Gold plan...what a misnomer!!! The lovely young admissions clerk at the facility to which she was discharged recommended we get her off Humana Gold ASAFP and get her back on "traditional" Medicare with a Part D Prescription Plan. She qualifies for Medicaid, so her care has been EXEMPLARY since we got her back on Medicare/Medicaid.

If you will need long-term major rehabilitation (speech/physical/occupational) and Skilled Nursing care in a facility, Humana Gold will screw you over. Her Neurology team had to have several peer-to-peer meetings with Humana's medical staff to get mother the care her doctors deemed necessary. At the end of the day, Humana was not going to cover her Skilled Nursing in the long-term facility because they had covered her emergent rehabilitation in the hospital post-stroke.

I wouldn't get a Medicare "Advantage" plan for my cats. To paraphrase a quote from Good Morning Vietnam, "It sucks the sweat off of a dead man's balls."

To add:
This was a VERY educational experience for me and my brother WRT aging and what insurance to get post retirement. I believe this convinced the both of us that any "advantage" plan sux anal sphincter and I will do like my brother did...sign up for Medicare, a Part D prescription plan, and a Part G "Medigap" plan.

I will admit that if all you have go wrong in your senior years is normal stuff like doctor visits, or illnesses requiring SHORT-TERM hospital stays, then an "advantage" plan might work for you...YMMV. HOWEVER...the second you have something MAJOR befall you, it's game over. You will have to claw and scratch to get the "advantage" plan to cover your long-term care, if it does at all.

My mother had an "Advantage Plan". In her final days she was shuffled from one facility to another. I paid over $10000 from her estate to cover the "Unplan".

My wife has been home three weeks after spending 10 weeks in Vanderbilt's Critical & Intensive care units, then 3 weeks in a Skilled Nursing home. Vanderbilt's bills were over a million dollars. She is now receiving 4 days a week of therapy at home, a RN comes to our home once a week, and a doctor makes a home visit every 2 weeks. My total out of pocket is $240 yearly Medicare deductable. This is with standard Medicare and a supplemental Part G. The only other costs have been my Part D prescription plan by Humana which had a $680 deductable for the anticoagulant she has to take.

She is now recovering well after 2 ear surgeries & 2 brain surgeries. The Neurosurgeon had given only a 20% chance of her living since the bacterial infection had encompassed much of her brain.

What I cant figure out is how I can get all kinds of free stuff OTC every fiscal quarter. Free. No cost. Someone's paying for this stuff. Who? And my plan is no monthly premium either.

Pay me now or pay me later.
There's no free lunch. There's a reason those expressions are so popular (and true).

Sooner or later Advantage plans will come back to bite you. They take advantage of people that don't do their due diligence and don't read the fine print. They sound great when you don't really need the coverage, when you're still in relatively good health. Low or no premiums, free goody's.

They are sold much like the financial investment seminars that invite seniors to a free dinner. They are the timeshare product of the senior health insurance business.

Once you are on one and start having any real medical problems and the bills start piling in, you will have a demonstration of what they didn't tell you. And it's very difficult to re-qualify for traditional Medicare.

There was a congressional hearing that compared profits of different insurance plans per enrollee. Medicare Advantage plans came out on top with profit per enrollee that were multiples of the other plans.

For people who are financially strapped, Medicare Advantage plans may be the only choice and I won't fault them for making the decision. But Medicare Advantage plans are like HMOs: you're limited to the plan's network of providers versus you can go anywhere in the country and see the doctor of your choice who accepts Medicare. The insurance company has a big say so about what treatments they will approve versus regular Medicare where the decision is between you and your doctor - if Medicare doesn't cover it, Medicare Advantage definitely won't. Those "extra benefits" has to be funded from someplace else and the only place where the funds can come from is from the money that funds your actual healthcare.

That is quite a testimony Anush. Prayers sent for your wife's continued recovery.

Also very sobering comparison of Advantage plans vs traditional Medicare. Thanks for posting.