Medicare Advantage (MA) plans can be deadly. Yet the upfront costs of enrolling in MA are low as compared with traditional Medicare and most people do not understand the risks they are taking when they enroll in MA. So, large numbers of older adults and people with disabilities are gambling with their health.
A new report from the Kaiser Family Foundation (KFF) explains that Medicare Advantage is costing taxpayers 20 percent more per person than Traditional Medicare, a total of $84 more this year alone. To be clear, the higher cost of Medicare Advantage is primarily benefiting corporate health insurers, which are profiting wildly from the program at the moment.
The report does not explain that in addition to MA’s excessive financial cost, it takes a huge toll on the lives of enrollees who develop costly and complex conditions. The data and news stories make clear that many MA enrollees struggle to get the care they need, and tens of thousands of them die needlessly each year.
Eventually, Congress is very likely to fix the defective payment system in Medicare Advantage and cut payments to corporate health insurers. When it does, corporate health insurers will simply shift more costs onto their enrollees. Tens of millions of older adults will likely see their costs rise exponentially when they need health care.
Right now, insurers can and do still bill the government higher rates than they should. They add diagnosis codes to their enrollee medical records that make them appear sicker and in need of more care than people in traditional Medicare. The insurers “upcode,” driving up Medicare premiums for everyone and eating into the Medicare Trust Fund.
Here are some MA trends:
More than half of people with Medicare (54 percent) are now enrolled in MA. Interestingly, enrollment growth in MA has slowed some. Perhaps, more people are reading the news and recognizing the many ways they might not get the care they need covered if they enroll in MA. The data show that insurers too often inappropriately deny and delay needed care, overruling treating physicians and leaving their enrollees to either forgo care altogether or pay out of pocket to get critical health care services.
A large and growing cohort of people with both Medicare and Medicaid are now enrolled in MA Special Needs Plans (SNPs). The insurers make even more money from these plans.
Nearly six million MA enrollees effectively had no choice but to enroll. In order to save money on retiree benefits, their former employers or unions negotiated a deal to move their retirees into MA. The insurers operating these MA plans saved money on marketing and provided these retirees with “extra benefits” as a way to get the books of business.
UnitedHealth Group (29 percent) and Humana (17 percent) are the two insurers with the largest number of MA enrollees.
Here’s more from Just Care:
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Expanding Medicare Advantage is a bad idea
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Medicare Open Enrollment: Don’t trust insurance agents
- Don’t trust your health plan’s provider directory
