Elizabeth Warren Urges Crackdown on Private Medicare Advantage Insurers

[BumRushDaShow]

Source: Bloomberg

March 5, 2024 at 10:00 AM EST
Updated on March 5, 2024 at 11:10 AM EST


Democratic senators led by Elizabeth Warren urged top Biden health officials to take a harder line on private Medicare Advantage health plans, arguing that insurance companies annually overcharge the government by tens of billions of dollars.

The lawmakers asked the administration to ensure “funds that are incorrectly going to” Medicare Advantage firms go instead to patients and medical providers, according to a letter sent late Monday to the leaders of the Department of Health and Human Services and Centers for Medicare and Medicaid Services.

The Biden administration has taken “unprecedented steps to improve transparency, use taxpayer dollars wisely, promote competition, and make sure people can get the care they need quicker” through Medicare Advantage, while cracking down on abusive marketing tactics, an HHS spokesperson said in an email. CMS didn’t respond to a request for comment.

Medicare Advantage, a private version of the federal health program for seniors, has driven growth and profits across the health insurance industry for years. The private plans covered 31 million people last year and the largest sellers — units of UnitedHealth Group Inc., Humana Inc. and CVS Health Corp. — enroll about half the market.

Read more: https://www.bloomberg.com/news/articles/2024-03-05/elizabeth-warren-urges-crackdown-on-private-medicare-advantage-insurers

[PortTack]

1. The RW long term plan to bankrupt Medicare!

When something sounds too good to be true…well, it probably is!

[erronis]

10. And have your heard about "Social Security Advantage"?

They let you invest your FICA payments into one of their special insurance companies that use the stock market to bolster your possibility of a wonderful retirement! One of the hottest companies is run by the trump spawn. What could go wrong?

Oh, prior approval before withdrawing may be necessary.

[Jacson6]

18. Yeah, Until the stock market & bond market crash and you are left with nothing. n/t

[SCantiGOP]

25. I don't believe there such things as Social Security Advantage plans

That is a name given to Medicare Part C (or Medicare Advantage).

[erronis]

30. Sorry - I forgot the 'sarcasm' tag/emoji/whatever.

[Quanto Magnus]

2. And they still deny care.... n/t

[Island Deac]

3. Watch out!!

Don't step into that "Donut Hole"!!

[Hope22]

4. It's insane that a private company was allowed to use the word Medicare in its name

Without being required to have an asterisk and a disclaimer right beside it saying it is not related to Medicare! People are warned that they will be boxed out of Medicare if they use these plans but they sign up, get the lost leaders and then are surprised that over time when they get screwed.

[Ms. Toad]

12. As much as I hate Medicare, these Medicare Advantage plans ARE Medicare.

They are Medicare Part C, which authorizes private insurances companies to use Medicare money to offer a plan which covers everything covered by Parts A, B, and D, and to impose cost-cutting measures in order to make them more cost-efficient. Unfortunately, they are just sucking money away from the rest of Medicare.

But the name comes from the laws which govern all of Medicare. Hospitalization is Part A, Medical is Part B, and drugs are part D.

[Hope22]

16. I did not know that. And over time they raise rates and lower coverage

And then people are so surprised that they were duped. Yes to the intended purpose of sucking off of Medicare for private companies gain. The intention is to kill Medicare. Raising prices on customers is a feature not a bug. And of course we would be remiss if we didn’t remind people that they can’t go back to regular Medicare if they chose MA first.

[Ms. Toad]

24. I've been screaming and yelling about Medicare Advantage programs

And trying to get everyone I talk with to at least start with original Medicare, since they can always switch to MA later, but they can't switch back to original Medicare.

I've had some success. But not enough.

[elocs]

37. I couldn't even begin to afford original Medicare being under the 100% FPL.

With my MA plan I pay nothing, have never been turned down for any procedure, and it helps to put food on my table every week. So you'll find zero success with me.

[Ms. Toad]

38. I hope you never have to regret that choice.

I know way too many people who chose MA when they were relatively healthy, and then were unable to afford it when they got sick and they consistently met the out of pocket expense every year ($8,850 this year, as long as you stay within network).

[hamsterjill]

39. Have a relative with Humana

It’s gotten absurd. She has to call an 800 number to try to get an appointment with her primary care, has to leave a message with the person who answers the phone, who in turn relays the message to the office of her primary care. It can take three days to get a return phone call from the primary care office to set up an appointment. When you’re sick, you don’t need to wait that long. Always frustrating.

Her primary care practice was taken over by Conviva which I believe is owned (in one way or another) by Humana.

I just turned 65 and there is no way in hell that I’ll do an advantage plan. What good does it do you if you can’t access care?

[KPN]

21. Use of Medicare money is not Medicare. Medicare is a federal government

service. Private corporations are not government services. The term Medicare Advantage is misleading.

[Ms. Toad]

23. Under the law, it is Medicare.

It is authorized by the same section of legislation which authorizes Part A, Part B, and Part D.

Medigap plans are also Medicare (Medicare Supplement) - and also run by private insurance companies. But they are very tightly controlled. What they pay is dictated by the government based on plan type. They don't get to evaluate claims and decide which to pay and which to reject.

The goal for Medicare Advantage should be - first of all - to provide a comprehensive education site written at about 5th grade level to explain the consequences of choosing Medicare Advantage. In addition, they should be controlled as tightly as the Medicare Supplement plans are, they should be limited to the same amount an original Medicare patient would receive, their profits should be capped, and their advertising should be limited, or abolish it via the law.

But until they change the law, insisting that a Medicare program is not a Medicare program would be misleading.

[erronis]

31. You're part right - by definition they fall under the "Medicare" umbrella

But they are not in any way tightly controlled by CMS.

They deny services under "prior authorization" when they don't want to provide the services that standard Medicare pays without question.

They do not save money - otherwise how would they become so filthy rich at the expense of the taxpayers and patients who can't get needed care.

[Ms. Toad]

32. I didn't say they were.

I said they need to be. Pretty big difference.

[NewHendoLib]

5. how else are they going to pay for their endless TV ads, mailings and spam calls?!

[KPN]

22. Right?!

[Blue Idaho]

29. To be fair

My wife will be making her Medicare selection this summer and she is being buried under a mountain of mailings from BOTH Medicare Advantage and Medicare Supplemental offers.

[pfitz59]

40. I turn 65 in 3 months.

Been flooded with mailers. I'm luckily retired military and am eligible for 'Tricare for Life'. Still have to buy Medicare Part B.

[RobinA]

41. I Found This

to be the case as well. They are both private company products.

[Silent Type]

6. I'd prefer to see Congressional leaders advocating for a system that doesn't force people into selecting

Medicare Advantage plans because they can't afford traditional Medicare's Medigap premium cost, need for some dental coverage (even if limited), etc.

Contrary to popular opion here, people aren't selecting MA because they are stupid. They are choosing it because they can't afford traditional Medicare with a supplement and drug plans.

I get GOPers are against anything that doesn't include private insurers. But geeez, Medigap and drug plans are private insurance, private insurance companies pay your doctors' and hospitals' claims for original Medicare; private insurance companies write coverage guidelines for traditional Medicare; etc.

[SCantiGOP]

7. Advantage plans are the biggest ripoff

Since Trump sneakers.

[erronis]

11. Way before those funny-looking moccasins.

[cstanleytech]

34. Well until they improve Medicare or the State Medicaid where I live the Advantage plan I'm using has helped me.

Mind you I'm not saying it's perfect but without it I would not have any dental coverage at all nor would my eyeglasses be covered and I need those as my vision is so bad that without them everything that's more than an inch from my face is literally be a blur.

[markodochartaigh]

8. ...has driven growth and profits across the health insurance industry for years.

This is a great example of messaging. "has driven growth and profits across the health insurance industry for years" should be replaced by "has scammed and stolen from Medicare".

[cstanleytech]

35. Sadly it's going to continue until they improve the benefits that traditional Medicare provides.

If they do that the APs would shrivel and die.

[Iwasthere]

9. Virtually all the advantage plans are total scams

[RobinA]

42. This Is Completely Ridiculous n/t

This isn't helpful to people trying to make informed opinions.

[Martin68]

13. I agree with Warren. Medicare Advantage is a scam.

[rwalt]

15. GoBlue

Total scam. Just another way for companies to take profits by not paying bills and it’s financed by taxpayers. Medicare Advantage should not have Medicare in their name.

[Nutty Putty]

14. Way Overdue

Being heavily involved with eldercare, I've had first hand experience with their strategy, as well as the nightmare of hours spent trying to get reimbursement for services that were incorrectly denied. Fortunately the hours were well spent because after three appeals, United Healthcare (Medicare Advantage plan) responded to the Administrative Law Judge: Oh, we took another look at case and decided it should be covered (paraphrasing). We're talking more than $10K here that we had to pay out of pocket.

Clearly the strategy is to deny coverage until they're forced to pay. To make matters more infuriating, the nursing facility staff is well aware of the rip-offs being perpetrated by these frauds and are telling people to drop Medicare Advantage plans.

Edit to add: isn't this theivery what Rick Scott was all caught up in???

[moonshinegnomie]

17. One partial solution

If you a top exec of a health insurer that defrauds Medicare.

You no longer qualify for Medicare no matter your age
You are also personally liable for damages due to the fraud

[Nutty Putty]

20. Good Solution!

Rick Scott does have some history:

During his tenure as chief executive, the company defrauded Medicare, Medicaid, and other federal programs. The Department of Justice won 14 felony convictions against the company, which was fined $1.7 billion in what was at the time the largest healthcare fraud settlement in U.S. history.

[cstanleytech]

36. Won't work unless it has teeth big enough to bankrupts the crooks as their millionaires if not billionaires.

[twodogsbarking]

19. Universal health care. Probably would be better and cheaper in total. How to divide the cost? Figure it out.

[Backseat Driver]

26. My daughter's employer went with a "health benefit plan" that is NOT exactly any sort of insurance plan yet their site

uses the same "insurance" jargon when talking up savings for the employer. There was no choice -- take it and provide early access to all prior medical records up front, or go without. She pays the same amount via payroll deduction as her previous insurance payroll contribution but no longer has all of the same benefits (no HSA). It's something of a start-up outfit partnered within an investment firm's portfolio of businesses. What do you think the chances are that her long-time, national, private family ,mid-size employer executive is also one of the investors in the same firm? Is this ethical or lawful? Is this sort of thing covered as a legit employer benefit under Dept of Labor's ERISA laws? This health benefits plan does no physician credentialing and does not participate in a network; it wants to participate in ALL networks, but it seems to pay claims individually per occurance under a "contract" with those providing care be that the hospital, clinic, physician, anesthetist, imaging personnel, or pharmacy/ist(s). To grow their "business," they encourage the patient who does have an ID card to take a form around to the various billing offices to accept this specific "benefit plan" that does no credentialing; EASY/PEASY...win-win for the employer--not so much for the patient-employee. She had a same-day out-patient procedure recently and claims to have been "balanced billed" for a lot of money. I've looked for reviews; we all know how that happens! No one's ever heard of this claim payor, hahahaha!

https://www.bvlp.com/portfolio/

Maybe we need to have Senator Warren investigate these rackets as well ?

[dalton99a]

27. Kick

[MOMFUDSKI]

28. I won't drop my MA Plan until we go

National Healthcare. The pols will have to solve this sticky wicket. Or not.

[Rhiannon12866]

33. Thank you Senator Warren!