'Misleading': Alarm raised about Medicare Advantage 'scam' -

'Misleading': Alarm raised about Medicare Advantage 'scam' - Raw Story - Celebrating 19 Years of Independent Journalism

Democratic U.S. lawmakers on Tuesday joined senior citizens, people with disabilities, and healthcare campaigners at a Capitol Hill press conference to kick off a week of action demanding Congress move to stop abuses by so-called Medicare Advantage programs peddled by profiteering insurance companies and "reclaim Medicare."

Congressional Dems, Activists 'Raise the Alarm' About Medicare Advantage 'Scam'

"It is time to call out so-called Medicare Advantage for what it is," said Rep. Rosa DeLauro. "It's private insurance that profits by denying coverage and using the name of Medicare to trick our seniors."

"We are here to raise the alarm about Medicare Advantage. We are here to protect our Medicare," Sen. Elizabeth Warren (D-Mass.) said to robust applause.

The Evolution of Private Plans in Medicare

Issue: Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans — now known as Medicare Advantage plans — have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. 

"This year, for the very first time, more than half of all beneficiaries are enrolled in Medicare Advantage instead of traditional Medicare," she continued. "But Medicare Advantage substitutes private insurance companies for traditional Medicare coverage, and that private coverage is failing both Medicare beneficiaries and taxpayers."

"Not only do Medicare Advantage insurers rip off the government, they routinely deny care to patients who need it."

"It's all about the money," Warren said. "Private insurers are in Medicare Advantage to play games to extract more money from the government."

"Experts estimate that Medicare Advantage insurers will receive more than $75 billion in overpayments this year alone, and that's the real punch to the gut," she continued. "Not only do Medicare Advantage insurers rip off the government, they routinely deny care to patients who need it."

History of Changes in Payment and Quality in Medicare Private Plans

Act	Payment	Quality Improvement and Measurement
TEFRA (1982)	• 95% of per capita traditional Medicare costs • Risk adjustment based on demographics	• Evidence of increased preventive care • HEDIS created in 1991
BBA (1997)	• Traditional Medicare spending controlled and capitation rate updates reduced by 2.8% • Rates fixed at 1997 level and adjusted to pay highest of floor rate, annual update of 2%, and blended rate • Risk adjustment based on health status and demographics	• No change in quality or quality measurement
BBRA (1999)	• Bonus for first risk plan entering market • Increase in traditional Medicare spending, on which plan payment was based	• No change in quality or quality measurement
BIPA (2000)	• Minimum update temporarily raised to 3% • Floors in rural and urban counties raised • Risk adjustment based on demographics and diagnostic categories	• No change in quality or quality measurement
MMA (2003)	• Highest of urban or rural floor, 100% of average county-level traditional Medicare costs, higher of 2% or national traditional Medicare cost growth update over 2003 rate, and blended rate update • Bidding system with rebate at 75% of difference between benchmark and bid	• Star rating for plan quality instituted in 2008
MIPPA (2008)	• No change in payment	• Quality reporting and provider network reporting mandated for PFFS by 2011
ACA (2010)	• Counties ranked from lowest to highest traditional Medicare costs and divided into four assemblages: county benchmarks at 115%, 107.5%, 100%, and 95% of county traditional Medicare costs • Rebates at 50% but higher at 65% and 70% for plans with 3.5–4 and 4+ stars, respectively • 5% bonus to benchmarks of plans with 4+ stars • Risk adjustment updated to correct for coding intensity	• Nearly 50% of plans had 4+ stars in 2017 • Enrollment in plans with 4+ stars

Reclaim Medicare (video)

"We can strengthen traditional Medicare, and by doing that, we can save money and we can use some of those savings to expand benefits, like hearing, dental, and vision... and add an out-of-pocket cap for all beneficiaries... and lower the eligibility age for Medicare."

"Medicare money should be spent to deliver services for people," Warren added, "not to boost profits for insurance."

Rep. Rosa DeLauro (D-Conn.) said that "it is time to call out so-called Medicare Advantage for what it is. It's private insurance that profits by denying coverage and using the name of Medicare to trick our seniors.

Like the lawmakers, Alex Lawson, executive director of the advocacy group Social Security Works, blasted "bad actors in Medicare Advantage" who he said "are delaying and denying the care seniors and people with disabilities need."

"Corporate insurance is designed to generate profits by delaying and denying care, harming and killing patients instead of providing care,"

Wendell Potter, who heads the Center for Health and Democracy, repeated the common refrain that "so-called Medicare Advantage is neither Medicare nor an advantage. It is simply another scheme by the insurance companies to line their pockets at the expense of consumers by denying and delaying care."

"The healthcare market is confusing for consumers and the misleading branding of calling private insurance Medicare only makes this worse," Potter stressed.

Progressive lawmakers have also criticized President Joe Biden for delaying promised curbs on Medicare Advantage plans amid heavy insurance industry lobbying.