On December 7, the 2022 open enrollment period for Medicare—the time of year when millions of seniors can choose the best Medicare plan to meet their health care needs—closed. But the truth is that for too many seniors, the choice can be both overwhelming and confusing. One of the main contributors to this confusion is a scheme by private insurance companies to prey on seniors and profit off of the Medicare brand, all in the name of padding their corporate profits and shareholder returns.
The scheme is called Medicare Advantage. But in reality, so-called “Medicare Advantage” is neither Medicare nor an advantage. It’s actually just private insurance that uses the trusted Medicare name to trick seniors and people with disabilities into enrolling, then profits by denying coverage for necessary medical care.
It is long past time for Congress to end this scam and ensure that consumers get accurate information about their health care options.
Unlike ads for prescription drugs, insurance companies are not required by law to mention the side effects on patients, but Americans deserve to know about the many disadvantages of Medicare Advantage. For example, unlike real Medicare, doctors often must get approval from the insurer in advance before treating their Medicare Advantage patients. Additionally, these private plans often have inadequate networks of doctors, hospitals, and other essential facilities. This stands in stark contrast to actual Medicare, where nearly all doctors and hospitals are available to patients without a referral.
It gets worse. In Medicare Advantage plans, if a patient knowingly or inadvertently sees a doctor or goes to a hospital out of network, they could be on the hook for thousands of dollars out of their own pocket. And these private plans’ networks typically cover only the patient’s home area, meaning doctors and hospitals, including centers of excellence, outside of the patient’s home area are considered out of network. Adding insult to injury, people enrolled in Medicare Advantage plans cannot buy supplemental coverage to help cover out-of-pocket expenses, unlike traditional Medicare enrollees. This means they could have to pay as much as $7,500 out-of-pocket a year.
Seniors aren’t the only ones getting scammed by these plans. The rest of us are too.
The New York Times recently reported, “Eight of the 10 largest 10 biggest Medicare Advantage insurers—representing more than two-thirds of the market—have submitted inflated bills, according to the federal audits. And four of the five largest players—UnitedHealth, Humana, Elevance and Kaiser—have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.”
The federal Medicare Payment Advisory Commission’s 2022 report to Congress found at least $12 billion in overpayments were made to Medicare Advantage plans in 2020 by the federal government.
And earlier this month, the Department of Justice filed a lawsuit against Cigna alleging that the company overcharged the government by tens of millions of dollars.
The facts are clear as day: These scam plans are bad for seniors and bad for taxpayers.
Only Medicare is Medicare. It is one of the most popular and important services the government provides. Congress should be working around the clock to strengthen and expand Medicare to include coverage for dental, vision, and hearing care. We cannot allow this Trojan horse for Medicare privatization to continue deceiving seniors and ripping off taxpayers.
The health care market is confusing for consumers, and misleading branding like private Medicare Advantage plans just makes it worse. But Congress has the chance to stand up for seniors with the Save Medicare Act. It will end this scam by renaming so-called “Medicare Advantage” plans, prohibiting private insurers from using the word “Medicare” in plan titles or advertisements, and imposing significant fines for any insurer that engages in this deceptive practice. The Medicare enrollment season should not be a confusing and misleading minefield for our nation’s seniors and others who depend on this essential program. Congress can and should pass the Save Medicare Act to end the Medicare Advantage scam and prevent any and all efforts to privatize Medicare. For our nation’s seniors—and for every taxpayer—it’s the right thing to do.
