Every year, most members of Congress send a letter to the Centers for Medicare and Medicaid Services filled with misinformation, drafted by the trade association for the health insurance companies that offer Medicare Advantage plans. This year was no different, even though the evidence remains undeniable that these corporate health plans are driving up Medicare spending, eating into the Medicare Trust Fund and putting tens of thousands of older adults and people with disabilities at serious health risk. Why do these policymakers append their names to this letter?
The Congressional letter is filled with unfounded accolades about Medicare Advantage. If you are in a Medicare Advantage plan, consider asking your Senators and representatives in Congress whether they signed the letter and, if so, why. If they want to serve your interests, they should be demanding accountability from Medicare Advantage plans not blindly extolling them when the evidence shows that their wrongful delays and denials of care and coverage and inadequate networks are putting members’ health and well-being at risk. Draw from the latest report from MedPAC, the agency that oversees Medicare Advantage.
According to MedPAC, Medicare Advantage has never produced savings for Medicare, and “the quality bonus program boosts plan payments for nearly all enrollees but does not meaningfully reflect plan quality, from the perspective of enrollees or the Medicare program.” Moreover, “plan-submitted data about beneficiaries’ health care encounters are incomplete, preventing policymakers from understanding plan efficiencies or implementing program oversight.” In other words, these insurers charged with “managing care” can’t even manage data properly or, as likely, they have reason to hide their data from scrutiny.
If you’re in traditional Medicare, you should ask your representatives in Congress why they are forcing you to subsidize care for people in Medicare Advantage through higher Part B premiums, and why they are permitting Medicare Advantage to continue in its current form. So long as plans are paid a flat fee upfront, regardless of the amount or cost of care they deliver, they are incentivized to withhold care or steer people to low-cost care providers. It’s a sure way to maximize profits.
As a result, Medicare Advantage plans require people to get prior authorization before covering their care, often do not have centers of excellence in their networks, and offer lower quality home health, skilled nursing and hospital care than traditional Medicare.
MedPAC sums up its findings by recommending a “major overhaul” of Medicare Advantage. As designed, the program lacks integrity.
Note: To be sure, some Medicare Advantage plans are far better than others and cover high-value care. We should never be generalizing about them, and it’s strange that we do. We would never generalize about automobiles or homes or virtually any other good or service in this way, when there is significant variation among them. The Medicare Advantage plans that are hurting their enrollees should be called out. Until we know which ones those are, the government is not meeting the needs of people enrolled in Medicare Advantage.
Here’s more from Just Care:
- Well-kept secrets of Medicare Advantage plans
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Biden administration bent on privatizing traditional Medicare
- How prior authorization requirements in Medicare Advantage could threaten your health
- Older adults in US face high cost-related barriers to care
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