Kay Tillow writes for Daily Kos about the “Medicare Advantage scam” and beyond. She explains that these for-profit health plans that deliver Medicare benefits are using stars like Joe Namath to mislead people into signing up for coverage that very well might not meet their needs if they get sick or need a lot of costly care. Medicare Advantage plans, in fact, could keep them from accessing critical care.
What Namath does not tell you is that if you choose the wrong Medicare Advantage plan, you might face inappropriate denials of care, along with other administrative and financial barriers to care. Indeed, new research finds that the wrong choice of Medicare Advantage plan might literally kill you. That’s what Yale economics professor Jason Abaluck found when analyzing data about these corporate health plans. But, the plans won’t let you have access to their mortality data, and Congress is not requiring them to give you access.
Instead, the Centers for Medicare and Medicaid Services (“CMS”) is allowing Medicare Advantage plans to send you to “the Medicare Coverage Helpline.” And, while you might think that it is a government, independent agency, it is in fact a corporate marketing agency, designed to seduce you into giving up your public health insurance under traditional Medicare and to sign up for a private insurance Medicare Advantage plan.
No question that you take a big gamble when you sign up with a Medicare Advantage plan. If you’re lucky and are healthy, you can save money because you won’t need to buy supplemental coverage, as most people need to do in traditional Medicare. But, if you get sick, you might find that you can’t see the doctors you want to see, your plan refuses to pre-authorize procedures your doctors say you need and, if you get care, the copays and deductibles add up to thousands of dollars.
Medicare Advantage plans generally offer some benefits that traditional Medicare does not offer, which is an attraction. But, you are trading away your ability to see the doctors and use the hospitals you want to use anywhere in the country without worry that your care will be covered. Moreover, Medicare Advantage plans can and do sometimes take a narrow view of what’s covered, refusing to pay for services that traditional Medicare pays for. And, the data show that they tend to offer lower quality care.
If you need nursing home care or home care, you are likely to find that the network providers are of poor quality. Medicare Advantage plans maximize profits by paying as little as possible for the care they provide you. So, that can often mean they contract with poor quality providers.
Namath makes it sound as if he is working for Medicare. That he is helping you. He does not explain that he is trying to get you to disenroll from traditional Medicare, the public health insurance plan. What’s worse, he does not explain that if you leave traditional Medicare and enroll in a Medicare Advantage plan, you very well might not be able to switch back to traditional Medicare. Unless you live in Connecticut, New York, Massachusetts or Maine, if you are in poor health and need costly care, insurers that sell supplemental coverage do not have to sell it to you.
And, if that’s not bad enough, you do not have anywhere near the information you need to make an informed choice about a Medicare Advantage plan. What’s the mortality rate? How frequently does it deny claims inappropriately? Has CMS found that it jeopardizes the health and well-being of its members? You can’t find this information. Medicare’s star-rating system is a farce and you should not rely on it.
Members of Congress on both sides of the aisle have been taken in by these for-profit companies. Maybe it’s because these lawmakers are heavily lobbied. Maybe it’s because of the campaign contributions they receive. Maybe it’s because they just have not had to focus on the horror stories. Senator Brown and five other Senators have hit a wall trying to understand why CMS is not holding Medicare Advantage plans accountable for their bad acts.
If you have a Medicare Advantage horror story to share, contact your Senators. Let them know. They need to understand why they need to preserve traditional Medicare. If traditional Medicare goes, everyone with Medicare likely will end up in a Medicare Advantage plan that is not likely to meet their needs.
P.S. The Medicare Coverage Helpline is owned by TogetherHealth PAP, LLC, which in turn is owned by Health Insurance Innovations. Health Insurance Innovations is enmeshed in two class-action lawsuits. It allegedly bilked Americans of millions of dollars. The FTC ended up shutting them down last fall.
Our elected representatives can continue to put their heads in the sand and ignore the predatory and unscrupulous behavior of corporate health insurers and their marketing agents. They can dismiss the reality that millions of Americans are being ripped off and tens of millions more are going without needed care. Or, they can close down the Medicare Advantage plans and guarantee us the health care we need through improved Medicare for all.
Here’s more from Just Care:
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- The wrong choice of Medicare Advantage plan could kill you
- Justice Department sues Anthem for Medicare Advantage fraud
- Medicare Advantage plans offer no real choice
Is any govt agency taking Joe Namath to court to stop this Mediaire Fraud?
Congress is the only one. But they have all been bought or paid in other ways. Why else would they not do anything about something that is so obviously wrong if they are not getting something out of it.
I doubt it and what I want to know is why he is peddling Medicare advantage plans when he’s a retired quarterback from the nfl I would hope he’s still got some money from his career to live on and if not then damn he’s got balls for trying to screw fellow senior citizens on health coverage
This program is a joke. Joe Namath is a joke. This healthcare is nothing but a ripoff. Why doesn”t Medicare come out and address this garbage?
I called and the minute I said let me think about it we got disconnected. I called back and they apologized and transferred me to another representative and I had to repeat all my information and answer all their questions again and the minute said I need to talk to my husband we got disconnected. I called back a 3rd time and they apologized and as we waited together to get another representative on the line, one came on, I wrote down his name this time and he said this is Safari. I said that’s him. When he heard me say that he hung up. She said that’s never happened to get the same person. She tried again I got a 4th person. I kept calling back because it had my interest. This girl seemed like I was bothering her. She seemed like she did not want to do this job to help me. She seem very bothered. I asked can you mail me this information? She said give me your Email address, I’ll send you a summery. She never did. Between all these calls I spent two hours on the phone. They are all nice to you until they feel you may not switch.
I think it’s a scam. I think these representatives get a commission, if they convince you to change. I thought I was calling a division of Medicare. I gave out personal information. I hope it doesn’t backfire on me and the use my information for identify theft.
Medicare Advantage is the old wellfare system that will make sure you don’t live past 80 years. I find it interesting when i had united health care community insurance before 65 that when you call up you talk to someone in South America. Aarp plan g with original medicare becouse I can go to any doctor don’t need referrals and any where in the usa. I also don’t have a drug program I don’t take any medication regularly and when I do the pharmacy always seems to get me a discount. What I would really like to know how much money is paying these private Medicare advantage plan per person from ower tax dollars? Good luck finding that out.
Joe is too stupid to realize what he is involved in. A case of bourbon every week is good enough for Joe.
As a SAFE reminder, all these marketing companies (like the one Joe Namath speaks for) are NOT affiliated with Medicare.gov. In fact it is right there for you in the very small print.
Best, SAFEST, option when looking at your Medicare options is ONLY go to site with,
” .gov ” at the end of the website. ALL the ” .com ” site are not affiliated, are for profit businesses. Never give your personal information on these sites as you could easily be scammed or subject to your identity being stolen.
no .gov will scam you to
How do we STOP commercials like this? Joe Namath, Joe Theisman, Mike Ditka, Jonathan with Colonial Penn.
Sue TV Stations for false advertising.
Medicare Advantage, by itself, is a disaster. I signed my Dad up for Medicare Advantage in Oregon many years ago … first, I looked at the program’s “physician directory” to reassure myself that indeed, there were lots of “approved” doctors in the network in every specialty.
What I didn’t know, and only found out later, is that just because a doctor is listed in the directory does not mean that doctor is actually accepting new patients. When I actually needed to get an appointment for my Dad as a new patient of a PCP, it turned out that out of the some 20 doctors listed in his town, only 1 clinic was actually accepting new Medicare patients. (The directory can list any doctor who HAS any Medicare patients, whether or not they are actually willing to take on any new Medicare patients. In my search, I spoke with physicians listed in the directory who had not accepted new Medicare patients in 3 or 4 YEARS. And yet, the Medicare Advantage directory was still allowed to show them as if they were doctors you’d be able to choose.) In the end, we had to wait SIX MONTHS for an appointment.
Your access to doctors when you need one is much, much, much better in Original Medicare. I was fortunate to be able to move my Dad during Open Enrollment the following year, and bought him a good supplement plan on top of it. I get very angry when I see Medicare Advantage being advertised to unsuspecting people who are very likely to need care … and unlikely to be able to get in a timely way if they don’t live in a major metropolitan area.
The same problems apply to ALL insurance medical provider directories, printed or web-based. Most are 2-3 years behind. Some as much as 5 years! Even the supposedly updated web-based directories that list those accepting new patients are not current. Their legal out is that it becomes the sick, injured, disabled patient’s job to contact and verify every provider, service and location’s participation…and that participation can change at any time without notification to the patient. Can you tell who is writing the legislation?
Yup, we live in an enlightented, moral judeo-christian nation all right…
These SOBs will continue to get away with the scam as long as they pay the “lawmakers” responsible for allowing the scam. I am so sick of companies being allowed to scam older people. Money talks, ESPECIALLY in politics! It is our job as voting citizens to clean house and vote them out of office!
yes they will NOT STEAL FROM ME
Get Joe off the air–he is intentionally misleading people about Medicare Advantage Plans because it is for his own pecuniary beneficial gain! I would rate his commercials as a -10!! (-10)
Medicare Advantage Plans. Prevegen. Car Shield. Choice Home Warranty. They are all shady money grabs put together by the wealthy investor class that ONLY brings in more funds from the rest of us to enrich themselves further. Its sad and frankly stupid to buy into any of this stuff. Please do your homework first but ideally, don’t even give any of these scams a second thought. If you do you will be disappointed.
Get Namath and ads off tv. They do nothing but lie. And besides we are tired off these stupid ads
Is there a legal way to get this crap stopped?
I have medicare advantage through United Healthcare since 1-01-21 and there have been some minor bumps along the way, but l had to have hernia surgery in June 2021. The total cost was $33,676.00 My total out of pocket was $325.00. Enough said.
Hey Corry! There are a (very) few legit advantage plans out there but I’m curious if you called one of these ‘help lines’ when you signed up or directly contacted to one of the big players ( like United Health or Giesinger etc etc) I’m pretty sure you did not. If you had, you wouldn’t be saying ‘enough said’
Hey Corry, I had colorectal surgery in 2017 and my hospital stay was 4 1/2 days. Thank God I had my own personal gastro-intestinal surgeon and was not assigned an ‘unknown’. My out of pocket expenses reached a total of $675. I had 4 follow visits with my surgeon over the course of the next 3 months. $0.00. My plan? Medicare ONLY!
I am tired of seeing all of the recognizable people on ads, but specifically JJ Walker saying he gets back $100 back every month from his zip code. Did he go on Welfare?
What a shame to more untruth being put on these ads. Enough of seeing these ads back to back
Makes me spew every time his commercial airs with him claiming he gets $100 back on his medicare monthly payment. He’s worth at least $1 million dollars and he says he qualifies fot the poverty subsidy? What bs! When will we demand an end to broadcasting outright verifiable lies?
I wonder if, but I haven’t seen anyone mention that, the mention of getting about $100 added back (refunded) to one’s Social Security check each month is only for those who also have Medicaid. Promoters in the ads mention “your zip code,” as if living in a “low-income neighborhood” is absolute proof that one is on Medicaid. (I came to that conclusion by the fact that we were getting mailings where we used to live, and the solicitation mentioned being on *both* Medicare and Medicaid.)
The commercials don’t mention Medicaid, so people are misled into calling and giving out information when they probably don’t qualify.
Joe Namath, JJ From good times and many others promoting fraudulent schemes to enrich insurance companies by taking advantage of millions of Americans.
Shane on them shame on Congress for allowing these scams to continue, many Americans have died because they didn’t get the care they needed.
Thank you Diane… I hunt advertisers for a living and this is one of the biggest scammers I’ve come across. When you call the 800 number and ask what company is behind it they told me “Goldhill”. Trying finding Goldhill for any medicare anything, doesn’t exist.
Back when I worked for FHP Healthcare in the 90’s, the industry was much more regulated. Apparently now they can get away with tricking the public to believe that this an actual medicare program. Wow!!! Scarry…
Is it ironic that these ads permeate True Crime Network programming???
I really hate it it when they say that they can “instantly look up your account” when you call the Medicare Helpline. That’s complete nonsense, no one has
access to your account without your log in information or authorization, and if
you’re dumb enough to provide that data, you deserve to be ripped off.
I see a lot of these commercials on The Weather Channel. Maybe we need to email them and call them and express our disgust and disapproval.
This stupid, lying ad about the Medicare helpline advantage plan also appears on the METV station as well. It also advertises the Car Shield ad which is nothing but a bunch of lies as well. I love the programs that METV shows but I no longer watch that channel just because of those ads that are shoved down our throat every 10 minutes. The govt. will never put a stop to these misleading ads because the politicians are to busy lining their pockets from lobbyist money!
What a waste! I called the number on the commercial, and got “number not in service.” I called the one on the “J J” commercial: same thing. If they waste money on commercials like that (TV ads cost big time)–why would ANYBODY want to fall for their scheme.
I have Medicare Advantage and had open heart surgery with a cost of a quarter million bucks. I had a private room, a nurse from the Advantage provider to over see my care, and with all this I was very concerned about what it was going to cost out of pocket. So my out of pocket was $ 450 dollars total. After about 15 years on this Advantage plan I have been satisfied with it. The surgeon was from a major big city medical center that did the surgery in 2008.
That’s great news, Mike. Which plan do you have? Some of them do appear to work for their enrollees, at least in some instances. The problem is that people have no clue whether they are joining a Medicare Advantage plan that will meet their needs if they develop a costly health condition or one that will impose huge costs on them and endless administrative barriers to care.
They use these old washed up broke guys come on Joe Namath and JJ what a joke get paid a bottle of wine to read lies of a script
A few monthas ago, I was on a Zoominar–sponsoried by IWMF, the International Waldenstrom’s Macroglobulinemia Foundation–with an insurance expert who said, “If you have cancer, it’s Medicare disadvantage.” I expect the same applies to other chronic conditions that might require all sorts of care as you age.
It’s all directed toward Medicare recipients to grab your information. This giveback effects a very low percentage of Medicare Advantage users. It’s provided by a few of BIG health insurance providers, Humana & Aetna are examples. They want you to switch to Medicare Advantage verses regular Medicare. It’s a data grab pure and simple. It’s the Hook to get you call and have them check. Stay away and save your money.
They denied my MIL of surgery after a fall because she was out of state and too old.
think about it. The Govt allows this poor quality replacement care that is often denied or extremely limited because it’s in their best financial interest to let the sick or low income seniors pass away sooner and get off the roles because they in most cases are no longer contributing to the system. OF course no politician, govt agency nor the media would every admit or even hint to this but their inaction to medicare and SS going broke in not too many years only supports this theory.
It is easy to say that I am just among the privileged and dismiss my comments. But in this matter, privilege is the just the ability to understand and the determination to act accordingly.
Now age 81, at age 65 I purchased Medicare Supplement Plan J in Florida (an Issue Age state, thus slowing premium growth). It covers the Parts A and B deductibles, excess doctor charges, ER care, and has saved considerable medical expenses, avoided delays, allayed worries, and allowed peace of mind regarding medical treatment. At any hospital or doctor, I just show my Plan J card and there are no questions. The medigap provider then handles all rest. (True, Plan J was discontinued two years after I purchased it but is grandfathered for those who want to keep it. [I wonder how many of us remain.])
More to the point, based on my career experiences, half or more of seniors on Medicare Advantage just vastly undervalue their own health. To put is bluntly, they do have the resources for a Supplemental, but they prefer things that offer immediate consumer, creature, and familial, and peer satisfaction.
THIS TOO–The older you get, the harder it is to recover from illness. And the added stress of finding the means of paying the medical cost (and the stresses of MA restrictions and denials) can prolong the illness. So having a good medigap plan will alleviate the stress and promote healing. Thus in a subtle way, in part, medigap helps pays for itself.
My wife and I gladly pay for Medigap and maintain a modest yet confident retirement. We don’t travel, nor go out dining, nor own a car, nor lavish our grandchildren, nor wear designer jeans, but neither did we pay a dime for her two knee replacements nor my dislocated shoulder, nor the nursing, nor the therapy, and with surgeons of our choosing.
My advice: force yourself to get medigap Plan G or N on your 65th birthday when you enroll in Medicare , and don’t lose it
Thank you so much for sharing your story. There’s no question that you can count on getting the care you need when you need it, without hassle, with Traditional Medicare and a Medicare supplemental plan. There’s also no question that you can never count on that in a Medicare Advantage plan.
Diane