A reader named Quickwrit summed up why “Medicare Advantage” is inferior to Medicare. Medicare is a federal program. Medicare Advantage is run for profit by private insurance companies. They make a profit by denying services.
Quickwrit writes:
WARNING TO ALL RETIREES!!! So-called “Medicare Advantage” plans TAKE YOU OUT OF FEDERAL MEDICARE and put you into A PRIVATE INSURANCE PLAN!!! So-called “Advantage” plans are aimed at privatizing all of federal Medicare for the profit of private insurance companies. Read pages 61 and 62 of your “Medicare & Me” booklet where it tells you that Medicare Advantage plans are PRIVATE insurance plans and that “each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you get your [medical] services.” In so-called “Medicare Advantage” plans you lose your freedom to choose your own doctors and you get hit with all sorts of out-of-pocket costs and copays. And you must use the “Advantage” plan’s so-called “Preferred Provider Organization” (PPO) doctors, specialists, and hospitals. The only “advantage” in a “Medicare Advantage” plan is for the private insurance company’s profits. More and more healthcare providers are dumping so-called “Medicare Advantage” plans and preferring Medicare Supplement (“Medigap”) plans. https://www.usatoday.com/story/news/health/2023/10/27/hospitals-terminate-medicare-advantage-contracts-over-payments/71301991007/
Quickwrit also wrote:
$600 BILLION MEDICARE ADVANTAGE FRAUD THREATENS THE CONTINUED EXISTENCE OF ORIGINAL MEDICARE
A new study published in the respected JAMA Internal Medicine reveals that privatized Medicare Advantage plans have defrauded U.S. taxpayers of at least $600 BILLION in recent years and calls for the abolition of the program before the ongoing fraud kills original Medicare.
“Medicare Advantage plans have, in effect, stolen hundreds of billions from taxpayers,” points out
Dr. Adam Gaffney, professor of medicine at Harvard Medical School and the lead author of the new study, said in a statement that “Medicare Advantage is a bad deal for taxpayers.”
“Money that could be used to eliminate all copayments or shore up Medicare’s Trust Fund is instead lining insurers’ pockets,” said Gaffney. “And the private insurers keep Medicare Advantage enrollees from getting needed care by erecting bureaucratic hurdles like prior authorizations and payment denials.”
Citing data from the nonpartisan Medicare Payment Advisory Commission, the report shows that Medicare Advantage (MA) plans have overcharged the federal government to the tune of $612 billion since 2007 — $82 billion last year alone.
PRIVATE MEDICARE ADVANTAGE INSURANCE COMPANIES ARE BANKRUPTING FEDERAL MEDICARE — which is the purpose for which the Medicare Advantage program was set up in the first place, so that nonprofit government insurance would die and private for-profit insurance companies could go back to business-as-usual.
Gaffney says that the time has come to abolish Medicare Advantage plans in order to save government Medicare.
Today, seniors feel trapped in so-called “Advantage” plans: https://www.npr.org/sections/health-shots/2024/01/03/1222561870/older-americans-say-they-feel-trapped-in-medicare-advantage-plans
Diane Ravitch's blog 
How shameful that one must supplement Medicare with a Medigap Plan. And pay the high Medicare standard premium.
It’s as if America had a standing policy that reads, F_____ old people.
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This country seems to have a policy to F_____anyone that is not wealthy whether young, old or different as long as the winners keep winning.
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Certainly seems that way.
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Guess why Medicare rates go up so much? Medicare Advantage plans!
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I have long suspected Medicare Advantage plans, but what cinched it for me was the huge amount of ads for it on You Tube for months at a time in the past year.
Struck me as a scam, and now I see it was a scam, the prelude to Trump’s plan to privatize all of our most essential services as seniors. It fits nicely into Republicans’ plans all along to do away with Medicare as we know it under the guise of “saving taxpayers money.”
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I understand and for the most part agree. Medicare Advantage, like much of ACA, is a sweetheart deal for the insurance industry at the expense of tax payers. However, after significant research and advice from an insurance broker who agrees with that assessment I had no choice but to go with Medicare Advantage. If I had chosen Medicare, I would be paying over twice as much per month for health insurance to get the same coverage. I don’t understand why I am required to even participate in Medicare at all given that my pension insurance was less than half of Medicare Advantage. We are all getting ripped off and yes, many of us with somewhat fixed incomes are captured by this private/public boondoggle. This makes the upcoming election even more critical. The problem with Biden’s boast of reducing insulin costs is that it has no impact on the medical expenses of the majority. We have to understand that ACA was no more than a stopgap measure to stop the bleeding for too many Americans that had no options for quality care. Yes, more Americans have health care after ACA, but it remains too expensive and the greatest single cause for bankruptcy in this country remains health emergencies. Continue to write your representatives that current healthcare policy remains inadequate and the insurors should not be driving reform. Meanwhile, I, along with most aging Americans, have little choice.
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I find it informative that a guy who puts words together the way you do had to go to a specialist ( the insurance broker) to understand the choices. As a person now negotiating the swamp of medical costs, I have been amazed at its complexity.
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Same here. I was utterly bamboozled, and I have been a professional editor and writer for decades. Who TF actually reads that enormous Medicare and You document? And what was said above about Medicare Advantage is exactly the case: they make everything difficult to keep from covering your treatment, including the totally bullshit preauthorizations, which you request and then are often not informed about whether they were granted. And then, they use technicalities (Yes, we preauthorized this, but the doctor submitted under a different code that wasn’t preauthorized, and this cannot be undone) to deny coverage. And every year, they make your coverage more restrictive for the same cost. They cover less and less.
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I have four siblings over 70 who could not explain the options to me clearly enough. My future prosperity is totally dependent on my ability, of course with the help of my smarter wife, to navigate all of these financial quandaries.
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Another privatization scheme that is trying to gain acceptance is ACO Reach. It is a way to insert a private manager into Medicare. It is a way to control care for seniors while it incentivizes denying care to the elderly. There is no practical reason for this as Medicare is explicit about what it does and does not cover. ACO Reach is a ticking time bomb that has been inserted into Medicare. Their goal is to shuffle most of us into ASAP, unless the public wakes up and demands its demise. It is a pay for success scheme that allows a wealthy overseer to take charge of care for seniors. When doctors spend less on patient care, the handler, usually Big Insurance or private equity, gets to keep the so-called savings. Like Medicare Adavantage it is a way to divert Medicare dollars into private pockets. ACO Reach is a way for big business to reach into seniors’ Medicare and grab money that should be going to patient care. It is simply another tool for robbing Medicare dollars. This program is Medicare Advantage on steroids. Few people know about this scam, but with expansion after bribing politicians from both parties, most of us will become victims of it. We need to pressure Democrats to abandon this manipulative privatization scheme. Privatization is like a snowball rolling down a hill until it becomes a massive form of theft of the common good. https://www.commondreams.org/opinion/aco-reach-medicare-privatization
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The power of this grift is overwhelming.
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Disgusting. Stealing candy from babies. Stealing healthcare from seniors.
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It Trump wins, he plans to make Medicare Advantage the default plan for enrollment. MA drains Medicare funds by dishonestly upcoding patient conditions to make more profit. The idea behind the plan is to hasten the demise of traditional Medicare. https://www.msnbc.com/opinion/msnbc-opinion/project-2025-trump-medicare-advantage-rcna160896
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This is awful. Speaking of for-profit… My family recently had to contend with a for-profit aspect of hospice. We were desperate and called a hospice that was recommended, but it happened to be a for-profit hospice. They pocket the majority of the money paid for hospice and hire temp agency types of nurses. Things were so abysmal that we absolutely had to switch hospice providers, and I made sure we switched to a non-profit hospice (and they were great and far more professional!). Fortunately, we had that option to switch, but in many rural areas the only hospice available might be a for-profit hospice.
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I well understand the dangers inherent in the privatization of public services, and certainly want Medicare to continue, but I feel I have to describe my own and my husband’s experience with Blue Cross/Blue Shield Medicare Advantage plans in RI. We each have been hospitalized within the past year, to the tune of many tens of thousands of dollars of bills. Neither of us had a problem getting authorizations for our treatment, or having our bills paid promptly. I even had Blue Cross go to bat for me when the provider incorrectly charged me for something that should have been covered. We each have Medicare Part A and pay the fee for Medicare Part B to qualify for the Medicare Advantage plans. Our premium for the plans is zero. Prescriptions are included. All of our providers are part of the network. What shocks me is the small percentage of the total bill that the providers are willing to accept for patients on these plans. Something is definitely way out of whack with our medical system. But for me, I’m pleased with my Medicare Advantage plan.
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I’m glad for you, Sheila.
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“What shocks me is the small percentage of the total bill that the providers are willing to accept for patients on these plans.”
Which is why more providers are refusing to take the plans.
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The supplement programs that make Medicare ok are run by private insurance companies. So, they are also taking folks money and denying care. We need single payer that covers everything. Otherwise, we need Medicare Advantage plans to avoid bankruptcy. They may refuse care for me in the future, but in the meantime, I can afford the care I need.
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When I first had to sign up for Medicare I sat down with a calculator as I read through the bulletin for that year. Clearly the Advantage Plans were much more expensive, and being in good health at 65 figured it would cost thousands more annually. So that was out. On to Medigap, which stated it would pay most(???) of costs outside of what Medicare would pay: nothing specific. No percentages. I passed on that. And took a leap of faith and went with MedicareA&B. My plain vanilla plan as I called it. Paid for eye glasses, vision exams and dental work out of pocket….and I was still ahead.
But the real serious test came recently with a total hip replacement operation. The total amount, charged by all the doctors, surgeons, nurses, anesthesiologist, physical therapists, hospital, operation, recovery facilities has come to over $110,000. With Medicare A&B my 20% (of the 80% Medicare payment) was $2591. The doctors I’ve spoken to about this is because they really like Medicare. They send in their bill, immediately, Medicare pays immediately, no questions ask, no hassle.
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I’m trying to take care of my widowed father, and I am so sick of all the scams directed at the elderly. Every single day there are multiple phone calls, phishing emails, etc.
“I’m calling from The Medicare Company and I just need to verify your card number.” No, you’re a scammer, and you need to find honest work.
But Medicare Advantage is advertised and normalized, but it’s still just taking “Advantage” of the elderly for the sake of profit. Medicare Advantage is merely a product name, and that’s misleading because it isn’t actually Medicare. Just get regular Medicare, and insist on it in yoru retirement plans.
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Medicare Advantage often inflates expenses, which in turn, drains Medicare dollars. It is the same parasitic relationship that public schools have with charter and voucher schools. The goal is to transfer public money into privatized options.
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Something else I should add:
Project 2025 requires that all retirees be automatically enrolled in a private, for-profit Medicare Advantage plan unless they opt to be enrolled in federal non-profit Medicare.
The purpose of Congress creating the for-profit Medicare “Advantage” plans in the first place was a gift to their insurance company donors to eventually phase-out non-profit federal Medicare. Now, if Trump is elected and Project 2025 is enforced, non-profit federal Medicare is as good as ended because you can bet that retirees will find it an obscure and difficult process to reject for-profit private “Advantage” plans and enroll instead in non-profit federal Medicare.
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G.W. Bush put this into place. While MAGA is awful, the mainstream Republican has always valued profits over public systems which always ends in poor service because the wealthy don’t care about providing a good service—they just want a vehicle to make as much money as they can off of the people. It’s the same old, same old. And Democrats are having “trouble” on the down ballot? Their messaging needs to include this.
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