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Medicare Advantage Plans Have Great Promise But They Are Not Delivering

Medicare Advantage (MA) managed care plans have the potential to vastly improve care for older adults in the US. A fully-integrated health model that combines primary and specialty care, physical therapy, hospital care and even some limited personal supports could improve the quality of life for patients and save the government a substantial amount of money.

But increasingly, analysts say these managed care plans, often run by for-profit insurance companies, neither save money nor deliver better care than traditional, fee-for-service Medicare.

One reason, they say, is that plans have gotten better at gaming the payment system. Because the government pays plans based on…

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Featured

  Medicare Interactive

Medicare Advantage offers an alternative to Original Medicare with different costs, networks, and coverage options. Learn how these plans work.

  We Found The Real Government Waste & Fraud. Trump Endorses It.

Dr. Mehmet Oz, the recently-confirmed administrator of the Centers for Medicare & Medicaid Services. says that he wants to expand Medicare Advantage — a program that former health insurance executive Wendell Potter calls “one of the biggest scams [...] we’ve seen in this country.” It lets private health insurers siphon tens of billions of taxpayer dollars to pad their bottom line, but is sold as a way for seniors to save money. In reality, it costs taxpayers 22% more than traditional Medicare. We investigated why Trump and Oz want this program to be even bigger, and who the biggest winners (and losers) will be if they do.

 Inappropriate Medicare Advantage care denials appear widespread

A recent report from the HHS Office of the Inspector General (OIG) raises serious concerns about inappropriate Medicare Advantage denials of care as well as wrongful payment denials. It shows that Medicare Advantage plans, commercial health plans that contract with Medicare to deliver Medicare benefits, overturn their own denial decisions 75 percent of the time. Unfortunately, most people do not appeal their denials.

 Privatization Scam Threatens to Replace Traditional Medicare Altogether by 2030

Medicare Advantage serves private health insurers and investors at the expense of the public interest.

 The Medicare disadvantage

How private insurers are gaming the Medicare system and committing fraud. Medicare Advantage, the private-sector arm for elderly care, is fast becoming the new battlefront in the fight against health care fraud in the U.S. Here’s why, and what fraud examiners think should be done.

 To cut ‘waste and fraud,’ reform Medicare Advantage

The program was supposed to save the government money. It doesn’t.

Articles of Interest

What Is a Medicare Advantage Plan, and Should You Sign Up for One?

The majority of Medicare Advantage plans are HMOs, which have a restricted network of doctors, hospitals and health providers, and offer less flexibility than PPO plans, which offer access to out-of-network providers at higher costs.

Beware Medicare Advantage Plans

An increasing number of seniors are choosing to get their Medicare benefits through Medicare Advantage plans. But do they understand what they’re signing up for?

Don't Believe the Ads! Medicare Advantage Propaganda

The ads falsely claim that traditional Medicare is rife with waste, fraud, and abuse due to improper payments that are supposedly “twice as likely” in ...

Medicare Advantage: The $1.2 trillion in government waste that Trump won’t cut

If the government were actually serious about targeting waste, rather than pushing costs onto low-income, senior and disabled Americans, they would be looking at the healthcare industry itself.

Medicare Cracks Down on Deceptive Advertising, Service Denials by Privately-Run Plans

Rule comes after criticism that Medicare Advantage plans were running misleading ads.

The Future of Medicare Advantage—Assessing Current Debates and the Likelihood of Near-Term Reforms

Privately administered Medicare Advantage (MA) has long been the subject of policy debate. To some, the once-nascent source of Medicare coverage is an important mechanism for injecting competition and innovation into the government-sponsored insurance program. To others, it represents an expensive and unnecessary alternative to directly administered traditional Medicare (TM).

The Great Big Medicare Rip-Off

The government is leaving billions of dollars on the table. Here’s how to fix it.

The Medicare Advantage Ripoff that Every American Should Know About

Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs…

The Medicare Advantage Trap: What They Don’t Tell You

Save your healthcare and dump Medicare Advantage before it’s too late. Here’s why you should return to real Medicare if you still can...

What’s Happening with Medicare Advantage and Why it Matters

Medicare Advantage stands today as a more effective and stable program than when it was born. It is a powerful means for Medicare patients to get more value out of their spending and to maximize benefits. Moving forward, the government’s regulatory relationship with the program will need to ensure that as more people enroll, it doesn’t result in more consumers, or the government itself, being taken advantage of.

As Seniors Get Sicker, They're More Likely To Drop Medicare Advantage Plans

Boosters say that privately-run Medicare Advantage plans, which enroll about one-third of all people eligible for Medicare, offer good value. They strive to keep patients healthy by coordinating their medical care through cost-conscious networks of doctors and hospitals. But some critics argue the plans can prove risky for seniors in poor or declining health, or those like Shipotow who need to see specialists, because they often face hurdles getting access.

Ending Overpayment in Medicare Advantage

A new Center for American Progress analysis finds that Medicare Advantage (MA) plans are overpaid by 22 to 39 percent; savings from curbing MA overpayments should be used to improve the Medicare program for all beneficiaries.

Medicare Advantage Plans Found to Improperly Deny Many Claims

Medicare Advantage plans, the popular private-insurance alternative to the traditional Medicare program, have been improperly denying many medical claims to patients and physicians alike, federal investigators say in a new report.

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.

Medicare Advantage quality ratings plunge as government resets to pre-pandemic standards

Federal officials significantly reduced the quality scores of next year’s Medicare Advantage plans, a move that was widely expected but will still affect millions of older adults and people with disabilities who have migrated to the growing program.

Medicare Advantage's cost to taxpayers has soared in recent years, research finds

Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.

Medicare is being privatized right before our eyes

The enormous success of Medicare Advantage — and the potential risks — explained.

Medicare’s Private Option Is Gaining Popularity, and Critics

As more Americans sign up for Medicare Advantage, detractors worry that it’s helping private insurers more than patients.

Pitfalls of Medicare Advantage Plans

Still, while many offer low premiums—sometimes as low as $0 per month—the devil is in the details. You will find that many plans unexpectedly won't cover certain expenses when you get sick—resulting in unforeseen out-of-pocket costs for you—and what they pay can differ depending upon your overall health.

Study: ‘Big Differences’ Between Medicare Advantage And Traditional Medicare But Seniors Like Both

Medicare Advantage is better about coaxing seniors to get preventive healthcare while traditional Medicare lands its beneficiaries in higher quality hospitals, an analysis of more than 60 studies shows.

There Is Too Much Medicare Marketing

With open enrollment in full swing, older adults can't escape Medicare marketing pushing them to sign up for private plans. Nearly all responding to a recent survey had been exposed to ads, some of which are considered fraud.

Uncle Sam wants you to help stop insurers' bogus Medicare Advantage sales tactics

Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 800-MEDICARE, the agency's 24-hour information hotline. Suspects include postcards designed to look like they're from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

Want to find the real waste in health care spending? Look at Medicare Advantage

Medicare Advantage costs the government 122% more per person than traditional Medicare. This amounted to $83 billion more in spending to the federal government last year alone. This setup is sending our Medicare program on the path to financial failure. And all that spending isn’t even for our care. Approximately 14% of spending in Medicare Advantage goes toward things like television advertisements and executive salaries. On top of that, the private companies that deliver these plans pocket an average of $1,730 in profits per enrollee.

Why Medicare Advantage Plans Are Bad

To be clear, Medicare Advantage plans are not bad in every situation. However, they are certainly not a good fit for everyone. We are here to clarify why these seemingly too-good-to-be-true plans have a less-than-stellar reputation.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Resources

Paying more for a Medicare Advantage plan is likely a waste

With Medicare Advantage, what you think is more could very well be less. Higher premiums and “additional benefits” may end up delivering far less than you might think. The problem is that you likely won’t find out the financial and administrative barriers to care you face until it’s too late to disenroll.

Medicare.gov

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).

MedicareFAQ

Medicare coverage can be confusing, and our goal is to make it easier to understand. Our trained and knowledgeable agents provide our clients with all the available options from top insurance companies.