The “No Unreasonable Payments, Coding, or Diagnoses for the Elderly” (No UPCODE) Act, S.1105 is a bi-partisan bill designed to strengthen Medicare. It would reduce by about 10 percent the $1.2 trillion in overpayments health insurers offering Medicare Advantage plans are projected to receive over the next decade, both bolstering the Medicare Trust Fund and reducing Medicare premiums. The Medicare Advantage insurers are pushing back. In so doing, they are making the case that they cannot and will not deliver as good health care as Traditional Medicare, if they see a $12 billion cut to the more than $80 billion in overpayments they currently receive each year.
The insurers are now saying that, if No UPCODE becomes law, they will do even less to ensure people in rural America enrolled in Medicare Advantage get the care they need. As it is, the insurers do not pay the rural hospitals adequately and, in part as a result, many of these hospitals are closing their doors. In addition, the insurers too often force their rural Medicare Advantage enrollees to travel long distances to get needed care and too often deny them needed rehab and nursing services.
The insurers’ claims notwithstanding, we know that they are pocketing much of the money they make to provide benefits to people with Medicare for their shareholders. Yes, if passed, the No UPCODE Act would eat into those profits, if they cared about ensuring their Medicare Advantage enrollees receive the care they need. But, no, covering reasonable and necessary care is clearly not their priority, so they make threats about what will happen if Congress ends some of their overpayments.
The government-administered Traditional Medicare program covers people’s reasonable and necessary care, without the widespread inappropriate delays and denials people experience in Medicare Advantage and at far lower cost per enrollee than the insurers in Medicare Advantage. And, Traditional Medicare does not block people from seeing high quality specialists or visiting cancer centers of excellence. Unlike Medicare Advantage plans, which limit coverage to their network providers, Traditional Medicare gives people wide choice of providers.
The No UPCODE Act is a relatively small but important step forward towards strengthening Medicare. Congress should pass it and follow it up with a bill that eliminates all overpayments to Medicare Advantage insurers. When Medicare Advantage was enacted, insurers committed to saving Medicare money. They have shown that Medicare Advantage actually is far less cost-effective than Traditional Medicare, weakening the program and driving up everyone’s premiums.
Here’s more from Just Care:
- Congressional Budget Office finds $1 trillion in Medicare Advantage overpayments
- Medicare Advantage: Denials and more denials, some deadly
- Medicare Advantage delivers unreliable coverage
- The most cost-effective way to strengthen Medicare
- Medicare Advantage insurers increasingly use step therapy for cancer drugs, delaying care
