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UE: New Report—Medicare Advantage Takes Advantage of Seniors

The privately-administered Medicare Advantage program is causing significant harm to America’s patients, providers, and health care system, according to a new report from Physicians for a National Health Program. Medicare Advantage harms patients’ health by limiting their access to treatments, physicians, and hospitals, while creating what the report calls “a massive profit machine” for insurers.

“Medicare was created to serve the people, and MA [Medicare Advantage] betrays that promise,” says the report. “We must rein in the abuses of MA insurers, eliminate profit-seeking in Medicare and beyond, and put an end to those egregious harms.”

Patients on Medicare Advantage are often misled about the size of the networks of providers that will be available to them. Patients on Medicare Advantage are forced to seek out prior authorization for treatments, tests, and necessary procedures ordered by their physician. The wait times for Medicare Advantage patients are longer than those for traditional Medicare, with many waiting weeks only to be denied care. These delays and inappropriate denials can have detrimental consequences to patient health and sometimes lead to death.

“We had a patient recommended for acute rehab. He was medically ready, but insurance denied him,” said a nurse and case manager in Illinois featured in the report. “We had to do an appeal, and we’re waiting on the results of the appeal, but he’s been here for 20 days, and 10 of those days have been us fighting with the insurance. In that time he’s developed pneumonia.”

Medicare Advantage plans lure seniors in by advertising dental, vision, and hearing benefits, but these perks are often extremely limited and do not meet patients’ needs. Medicare Advantage plans do not have the same coverage as traditional Medicare for patients that become chronically or seriously ill, making them pay thousands of dollars for their care and rack up medical debt. This disproportionately affects the most vulnerable seniors and exacerbates the inequities in healthcare.

Patients who realize the many problems with Medicare Advantage then try to switch to traditional Medicare are often unable to. In all but four states, insurers are allowed to deny Medigap coverage to patients who have been enrolled in Medicare Advantage for more than a year. Without Medigap coverage, the out-of-pocket costs of traditional Medicare are unaffordable for many. This forces many seniors to remain in Medicare Advantage plans despite their flaws.

According to the report, Medicare Advantage hurts not only the patients but the physicians, nurses, and other health care workers who face hurdles caused by Medicare Advantage that prevent them from caring for their patients. Healthcare workers have to spend hours filling out authorization forms and fighting with insurers to get necessary care approved. On top of this, Medicare Advantage causes delayed payments for treatments and sometimes refuses to pay altogether, a financial drain on hospitals and medical practices that already have limited resources.

The report explains how Medicare Advantage represents the worst of private insurance taking over the best system of health care that America has to offer. “Insurers in MA prey on some of the most vulnerable among us, luring them in with false promises of superior coverage and low costs only to make every effort possible to prevent them from accessing necessary health care, all while siphoning billions of dollars from taxpayers,” says the report.

As Medicare Advantage continues to expand, more seniors, physicians, and hospitals will be harmed. More people will die waiting for their healthcare to be approved by a system that puts profit above patients. The report concludes that the money going to profit-driven insurers in Medicare Advantage should instead be used to improve traditional Medicare and take Medicare back for the people.

The United Federation of Teachers in New York City has withdrawn its support from the city’s plan to switch retirees to Medicare Advantage after rank-and-file members fought against the plan. The union put out a statement saying, “If retirees are forced off of traditional Medicare and into the City’s new Medicare Advantage plan, thousands will be denied access to the doctors they depend on and the medical care they desperately need.”


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