Corporate health insurers must stop taking advantage of people in Medicare Advantage plans, denying and delaying their care inappropriately, often to the detriment of their health. Corporate health insurers also must stop gouging Medicare and taxpayers through tens of billions in overcharges, driving up Part B premiums for everyone with Medicare. Here’s what Be a Hero , a not-for-profit organization fighting for a more just health care system in the United States. has to say:
Health insurance corporations are gouging Medicare, taxpayers, older adults and people with disabilities by tens of billions of dollars each year, while wrongly delaying and denying the care people need, with impunity.
While some people on Medicare Advantage are currently satisfied with their plans, when they become ill, they face serious risks of inadequate care. The failure of Medicare Advantage to live up to its promise is placing the very integrity of Medicare in jeopardy.
Neither federal law and regulations, nor the Centers for Medicare and Medicaid Services (CMS) are doing enough to protect older adults and people with disabilities from Medicare Advantage bad actors and to ensure that federal dollars spent on Medicare Advantage are put to good use.
We believe that Congress has a responsibility to protect the rights of, and advance health equity for, everyone with Medicare—including older adults and people with disabilities on Medicare Advantage plans.
The Problem
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Health insurance corporations are denying care they are supposed to cover in Medicare Advantage and putting older adults and people with disabilities in harm’s way
The Health & Human Services Office of the Inspector General has twice reported that health insurance corporations are engaged in widespread and persistent care denials in some Medicare Advantage plans. These delays and denials lead to outsized profits for insurers, but they lead to serious harm for older adults and people with disabilities.
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Health insurance corporations are gouging the federal government and taxpayers
Insurance corporations are illegally overcharging the government as much as $73 billion this year alone and people on Traditional Medicare and taxpayers are footing the bill. This insatiable profit seeking is eroding the Medicare Trust Fund and driving up costs for people in Traditional Medicare, who will pay $145 billion extra in Part B premiums over the next 8 years to subsidize Medicare Advantage.
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Health insurance corporations are not being held accountable for their bad acts in Medicare Advantage.
The Centers for Medicare & Medicaid Services rarely if ever penalizes insurance companies that inappropriately delay and deny care and endanger the lives of their enrollees, let alone cancel their contracts.
What Congress Can Do About It
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Ensure older adults and people with disabilities can access the care they need.
Congress should take action to combat rampant and wrongful delays and denials of care by requiring the Centers for Medicare & Medicaid Services to force corporate health insurers to comply with Medicare’s standards. But, perhaps the most important thing Congress could do, is to give people a meaningful choice of quality health care they can rely on by strengthening Traditional Medicare with an out-of-pocket cap and by adding dental, vision and hearing benefits.
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Stop corporate health insurers from scamming the government and profiteering at patients’ expense.
Congress should take action to change the payment system that allows corporate health insurers to profit off making their patients look sicker than they actually are. The current system also incentivizes insurers to offer low quality provider networks and to delay and deny care—making it hard for people to get the care they need.
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Hold the bad actors accountable.
The rampant, inappropriate delays and denials will never fully come to an end without real accountability. Congress should require the Centers for Medicare & Medicaid Services to complete rigorous annual monitoring of compliance across the plans of the top 15 Medicare Advantage insurers (who together are responsible for the lion’s share of enrollees) and provide them with the resources to do so, implement a series of automatic, escalating penalties on plans and insurers that fail to comply with contractual obligations and require automatic cancellation of contracts or barring of offending insurance corporations from the Medicare Advantage market in the face of persistent compliance failures.
For More Information
This fact sheet was prepared by Be A Hero & Just Care USA. If you’d like to learn more email us at [email protected].
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