For-profit healthcare companies, many of which are owned by private equity, are aggressively expanding their efforts to trick seniors into abandoning their enrollment in traditional Medicare and joining for-profit Medicare Advantage plans.
About half of all seniors are now enrolled in Medicare Advantage. The pitch for MA plans is seductive. They offer bells and whistles that are not part of Medicare. If you enroll in a MA plan, you will get free gym membership, prescription drug coverage, dental coverage, and a variety of other attractive benefits.
What’s wrong with MA? It’s great when you are not sick. It’s very bad when you have a serious illness.
When you have surgery or other serious illness, Medicare and your secondary pays almost all of your medical costs. MA may or may not. MA has panels to decide whether to pay your bills. You may be denied and stuck with huge bills.
Privatization produces worse service because the corporation must turn a profit. Make no mistake: MA is privatization.
How does MA make a profit? By denying the claims of patients.
I had open heart surgery in 2021. I was hospitalized for a month. I spent a week in the ICU (intensive care unit). When the total hospital bill arrived many weeks later, I almost had a stroke: it was over $839,000! After Medicare negotiated with the hospital, the actual cost to me was $300. That’s a miracle. Why give up that kind of coverage?
The Lever reports that the federal government has been complicit in tricking people to abandon Medicare and switch to Medicare Advantage.
It begins:
A new Medicare privatization scheme developed under President Donald Trump and now being expanded under President Joe Biden is forcing hundreds of thousands of seniors onto new private Medicare plans without their consent.
The development represents a troubling new dimension in the fight by corporate interests to privatize Medicare, the federal health insurance program for people 65 or older. Medicare Advantage, which allows for-profit health insurers to offer privatized benefits through Medicare, already results in unexpected costs for routine procedures and wrongful denials of care. Private plans have cost Medicare an astonishing $143 billion since 2008, and are now drivingsome health insurers’ record profits.
The new Direct Contracting Entity (DCE) program similarly adds a private-sector third party between patients and Medicare services. Medicare allows these intermediary companies to offer unique benefits, like gym membership coverage. But as for-profit operations ranging fromprivate insurers to publicly traded companies to private equity firms, these intermediaries are incentivized to limit the care that patients receive, especially when they are very sick.
While Medicare Advantage patients choose to sign up for private insurance plans, patients are being enrolled in these DCE health care plans without their informed consent. As Rep. Pramila Jayapal (D-Wash.) noted in a January op-ed, “Seniors in traditional Medicare may be ‘auto-aligned’ to a DCE if any primary care physician they’ve visited in the past two years is affiliated with that DCE. That means Medicare automatically searches two years of seniors’ claims history without their full consent to find any visits with a participating DCE provider as the basis for enrollment.”
Open the link and continue reading.
Don’t be fooled.

I agree that we are basically subsidizing health insurance companies through ACA and Medicare Advantage while they make record profits and deny coverage. The entire concept of insurance is contrary to the Hippocratic oath. However, I simply could not afford the same coverage with Medicare. The greater sin here is that our representatives at the state and local levels are ok with robbing tax payers while we are unwilling to hold them to account. In the 2018 midterms, the Democratic Party won decisively on health care. Yet, in 2024 we heard very little about this issue that is crushing middle class America. As long as the electorate buys the snake oil of politicians in the back pocket of the insurance lobby, this problem will continue.
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I don’t know if this is true or not, but you might be able to afford Medicare if 50% of seniors weren’t in Medicare Advantage programs instead. Medicare is left to serve the (lucky) seniors with more medical needs, which means that those of us who can still afford it pay more as healthier seniors opt for the bells and whistles and the lower cost of a healthier pool. Just don’t get sick. If I have to fill out another claim form it will be too soon.
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Yes! That’s why New York City public service retirees have waged a three-year battle against the City and, sadly, our former unions, who planned to switch us to a privatized “Advantage” plan without our consent or, in many cases, knowledge. Despite our 11 court wins, the City and the largest public-service unions continue their relentless appeals, and the City Council mostly declines to back a bill that would enshrine our rights. Those wanting to know more can visit the New York City Organization of Public Service Retirees at nycretirees.org.
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The link to The Lever is not working.
The Direct Contracting Entity is now known as ACO Reach. This program is being expanded at a rapid pace often without the recipient’s consent or knowledge. It was a compromise “Trojan Horse” that was inserted into Obama’s ACA. There is a lot of positive propaganda about how the arrangement with enhance equity, coordinate care and result in better care outcomes. I believe this as much as I believe that more choice will improve public education. It is the same type of phony hype and spin that surrounded school choice. Please do not fall for it because the goal in my opinion is to privatize Medicare from the inside out. What ACO Reach is a “pay for success” scheme that places a corporate gatekeeper between the Medicare recipient and access to their healthcare. All the big hospital chains, Big Insurance, physician networks and private equity are joining this program because it is “free money” for them. Many participants are the same providers that have been fleecing Medicare through Medicare Advantage. They get to keep up to 40% of the Medicare payout by “managing,” a euphemism for denying access to, care. It is getting increasingly difficult to find a provider that is not a member of ACO Reach. As of now, people can refuse to participate by calling Medicare at 1-800-633-4227. I called them last week, it was easy to do. According to the clerk that answered the call, people may continue with their current provider if that provider accepts Medicare, but opt-out of ACO Reach participation. This program is set to expire, but it likely that it will be renewed with complicit politicians involved in the decision. I read somewhere their goal is to get all Medicare recipients into ACO Reach by 2030. I am concerned that under GOP leadership opting-out may no longer be an option in the near future.
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There is no need for corporate profiteers to be in charge of people’s Medicare which is highly efficient, and its administrative costs are much lower than those of Big Insurance. Medicare is also very clear about what is covered and what is not. There is an appeals process for anyone whose claim has been rejected. Bernie Sanders will not longer be Chairman of the Senate Committee on Health, Education, Labor, and Pensions under Trump. People should complain to their representatives against any corporate involvement in Medicare which was created because seniors cannot compete in the market.
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Here’s a clear explanation of how ACO Reach plans to privatize Medicare. https://www.commondreams.org/opinion/aco-reach-medicare-privatization
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Maybe one reason why Biden was so unpopular?
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Because of ACO Reach? Huh? Can you imagine any Republican trying to take down Biden by claiming he was trying to destroy Medicare? Sure…
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Trump allowed the assault on Medicare by allowing various for-profit groups, hedge funds, etc., to buy up medical practices and run them as a regular for profit business which is what ACO’s are. I believe they originally had a different acronym during the Trump Admin. When Biden became president he continued the program but faced mounting pressure from retiree groups and was forced to cut back on the worst parts of the program. The title was changed resulting in the new acronym ACO. Still it is an attack on Traditional Medicare hence the continued growth of Medicare Advantage resulting in further draining of the Medicare fund.
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Trump admin allowed private entities including hedge funds to buy up medical practices and run them as regular businesses to maximize profits. Biden continued those policies but was forced to cut back from the worst aspects due to pressure from retiree groups. The fact that Medicare Advantage continues to expand at the cost of Traditional Medicare is a result of the policies of both Republicans and Democrats.
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If there is anything you should have learned from the Biden administration, it’s that getting anything done when you have a Congress intent on thwarting you takes a master politician who knows that to get anything done compromise is essential. Nobody gets everything they want. Just look at the bi-partisan immigration bill that was set to pass until Trump told the Republicans to kill it, so he could use immigration as a key campaign topic. Why anyone bought his bluster on that issue after killing the bill negotiated by Congress is beyond me.
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Agreed. That said Biden did not need congress, as I understand it, to reverse Trump’s policy on privatizing Medicare.
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The New York retirees proved that it’s not always simple to refuse Medicare Advantage. Anthem BC-BS announced last summer that it was converting many if not most of its Medicare supplement plans for retired NH public employees to MA. My wife and I could have switched out to another supplement, but…. We would lose the subsidy we receive from the NH Retirement System, and then there are those “preexisting conditions.” And I doubt there’s the kind of readiness for a fight that our NY counterparts displayed.
At some point I expect Anthem to pre-reject some of my treatment, and I’ll be prepared, sorta. I’m ready to stand in the most visible places I can find with a sign to the effect:
Anthem BC-BS has given me a choice
Drop Dead or Go Broke
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This post is an important public service. Thanks.
When I taught economics to 12th graders, I spent at least three class sessions specifically on health insurance including my own horror story of when our insurance got messed up and the subsequent fight with the insurance company that went on for months.
I’d show the students our bills with the personal info redacted, of course. I did a whole unit on insurance in general.
So, yeah. And, aren’t those medicare so-called advantage commercials each fall like torture..
On a MUCH lighter, medical note…..
My wife had a routine colonoscopy yesterday morning.
In the moments after she woke up from the sedation, one of her first comments was something to the effect, “Is Trump still the president?”
She then launched into details about Sleeping Beauty and how perhaps she’d been out of touch with the world for 100 years.
Nope. Trump is still here I sadly had to report.
And, folks, THAT’S an example of the kind of effect FELON47 is having on humankind. Talk about permeating our psyches.
P.S. my wife is here on the couch as I type and she said it’s fine if I mention her medical procedure on the blog. All was well. But she has no recollection of her Trump comment.
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John,
Something similar happened to me when I awoke from open heart surgery. My son said that I said, “I believe in democratic socialism,” words to that effect. I have no memory of that.
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That’s wonderful.
Sounds like a true believer to me!
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‘Out of Control’: Insurance Giant UnitedHealth Calls in Middle of Cancer Surgery to Question Necessity | Common Dreams
https://www.commondreams.org/news/united-healthcare-surgery-coverage
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As a retiree, I had been happy with our district’s plan. Rising costs caused them to change our plan to a MA. Then that company dropped the district. They then allowed us to go back to original or another offered MA plan(that 3 major hospitals in NY did not accept!) They said that we could always fill out extra forms to resubmit for coverage. Yeah, no. I am paying @6x more than the MA but I didn’t want to take a chance. 2 open heart surgeries and possibly one in my future so I did not take that chance. That and knowing how the advantage plans are stealing funds from Medicare.
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Aren’t the MA plans “Medigap” plans that pay (ie “suppplement”) the patient’s portions of Medicare Part B? Or is Medicare Part B fully funded bsince Obamacare kicked in (which would free seniors from the so-called “customary & reasonable” provider fee schedule that left them with hefty co-pays)? Just wondering, since I’m with a MA plan from Kaiser.
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Right on target !!!
Keep in mind how the Government from Democratic Party days forced our active and retired military to pay for their promised health care, but illegals get for free.
Add the fact that most Americans are not aware of, but those of us who retire from military service, but endure with disabilities incurred, get no VA compensation in addition to our retiree paychecks, but as Income tax deductions – hence worth far less than the VA award itself.
In the civil sector this would not be the policy, but when one looks how Congress rewards itself in benefits that outstrip those of our military personnel, why would one think they would treat their citizens any better?
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In the NYC Council, only Republican members and one independent, (but not 100% sure) support retirees in the fight to keep their Traditional Medicare. Also of all the Democratic Party groups in NYC only one has supported the retirees in this fight.
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For the past year or so I have been posting the following warning on the Facebook pages of AARP and on the pages of various insurance companies and groups that tout Medicare Advantage plans. Medicare “Advantage” plans started out being labeled as “Medicare Risk” plans in the law, but in 2003 insurance companies got Congress to change that so that they could market their private plans as having an advantage over standard federal Medicare. Anyone who wants to copy and post the following can feel free to do so:
WARNING TO ALL RETIREES!!! So-called “Medicare Advantage” plans TAKE YOU OUT OF FEDERAL MEDICARE and out 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. And Project 2025 will make these private “Advantage” plans the automatic plan into which new retirees are enrolled. This will quickly destroy non-profit federal Medicare.
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 must use “in-network Preferred Provider Organization (PPO) doctors, specialists, and hospitals doctors and hospitals — plus, you get hit with all sorts of out-of-pocket costs and copays.
Only “MEDIGAP” supplemental plans allow you to remain in non-profit federal Medicare and leave you free to choose your own doctors and hospitals.
The only “advantage” in a “Medicare Advantage” plan is for the private insurance company’s profits — and more and more doctors and hospitals are done with it and are ENDING THEIR ACCEPTANCE OF “ADVANTAGE” PLANS. Click on the following to see why: https://www.usatoday.com/story/news/health/2023/10/27/hospitals-terminate-medicare-advantage-contracts-over-payments/71301991007/
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Late to the conversation as I’m behind in reading email.
When I hear about this I get very nervous. I’m retired, in my 80’s. Through my pension fund I’ve had a Medicare Advantage plan for a few years. Actually it is United Healthcare. I never realized I no longer have Medicare.
For the past 3 years I’ve had one medical thing after another — hospitalization, surgeries and treatment for breast cancer and thyroid cancer, broken elbow and surgery, aneurisms, tests, scans, and am sure I’m leaving things out. I have to say that every single thing has been covered without any effort on my part. Every thing. Without a question. From my plan.
Am now scared that coverage will change or run out and need to learn what to do …
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