Medicare Advantage Exposed

Editor’s Note: This article was written by Jack Prince, a retired teacher who lives in Grand Rapids.

Medicare Advantage is neither Medicare or an advantage! It is not a social program but rather a private insurance plan making billions of dollars for private insurers. Medicare Advantage (MA) is a scam covered and disguised by a deceptive moniker devised and perpetuated by conservative corporate cohorts with George W. Bush. Bush knew he had to hide his maneuver to privatize Medicare so he used the same trusted name Medicare coined in 1965 for socialized care with the added descriptor Advantage for private insurance! That sleight of hand was sufficient in convincing millions that Medicare Advantage is just medicare improved! When in actuality it is private insurance with the bill paid by medicare in an incredible fashion unknown by most Americans. Once a person is enrolled in an Advantage plan it’s difficult to undo and if they remain for over a year they are not able to return to regular Medicare with a Medigap plan at all. 

Once trapped here are some of the disadvantages to MA: 

1.Unlike Medicare doctors must get approval from the insurer before being able to treat their MA patients.
2. The private plan many times has inadequate networks of doctors, hospitals and essential facilities. This stands in severe contrast to actual Medicare where nearly all doctors and hospitals are available to patients without referral 

3. When a patient knowingly or accidently sees a doctor or or goes to a hospital out of network they will pay thousands of extra dollars out of their pockets.
4.Even worse the private plans have networks that typically only cover the patient ‘s home area meaning doctors and hospitals including centers of excellence outside of the patient’s home area are out of network. 

5.People enrolled in MA are not allowed to buy supplemental coverage to reduce out of pocket expenses, unlike original Medicare enrollees. That can mean additional payments as much as 7000 to 8000 dollars per year.

6. MA consistently has been known to refuse claims payments for a plethora of reasons. 7. The excessive cost to taxpayers because of the overpayments by the government to a private program that costs 6 -7% more to operate than traditional Medicare. (Stop the Medicare Advantage Scam before Medicare is dead Medium 8/5/22 Taxpayers Cost)

Then President George W. Bush with willing congressional Republicans and fellow neoliberal Democrats created the MA racket in 2003.Since that time it’s estimated that over a trillion dollars of taxpayer money has landed needlessly in the pockets of private insurers that could have replenished the actual Medicare fund and ensured its longevity. “Just the overcharges happening now with MA are costing Americans over 140 billion a year which is more than the entire budget for the original Medicare Part B and D program. These ripoffs that no one seems to have an interest in stopping are draining the Medicare trust fund while trapping gullible seniors exposed to 24/7 MA television ads into the private program where they are often denied life-saving care! It must be remembered that real Medicare pays the claim the minute they’re presented. MA however has a person in a corporate cubicle somewhere who delineates what charges get paid. MA gets paid a calculated amount of money each year in a lump sum of tax money before any medical service is even rendered to the people enrolled in MA. Payments to MA plans boosted Medicare Spending by 7 Billion in 2019 alone and have increased measurably since then! The federal government spent 321 dollars more on each person on MA in2019 than they would have if they had been on Traditional Medicare! MA spending is expected to rise to 664 billion per year by 2029 doubling what it is presently! Imagine the federal government giving a private grocery store millions of dollars the first of January for a specific group of people to be doled out throughout the year and the private grocery can keep any money left over at the end of the year! To emulate this analogy with MA the grocery executives would send out so called concerned workers to question the hunger and eating needs of the designated group then inflate their findings to request more money from the government! Next they would reduce the quality of food for their own profit while reducing their outlets of distribution to limit consumer accessibility! Lastly they would simply refuse to give food insisting it’s not really necessary recommending gym membership and fasting. With the profits realized with such a scam the grocery would use some of their money to advertise for increased membership to the specific group using bodybuilders and famous athletes to espouse their lies! They would saturate the media i.e the Television with their great offer non stop 24/7 for months all the while knowing that the less you would eat the more they would make! I personally experienced an MA visitor for a health check in my home who then exaggerated negatively my health evaluation to increase the government’s pre-payment to MA. It is crucial to realize MAs real concern is for the profit and wellbeing of their shareholders and CEOs while Actual Medicare does not seek a financial profit for anyone! 

These tactics and more are elucidated in the doctors group Physicians for a National Health Program (PNHP) which has recently published a shocking report on the extent of the MA ripoffs which greatly impacts individual customers and Medicare itself! 

Hospitals and Doctors Refuse to honor Medicare Advantage

If you consider treatment when on MA they will consistently second guess your decision and try anything to intimidate you into paying out of pocket! They are infamous for urging people considering hip or knee replacement to only get therapy or exercise more to escape surgery. Many times they will simply refuse payment after a procedure to see if you will file a complaint against them. As a result hospitals and Dr. groups across America are beginning to refuse to take Medicare Advantage Patients. (Hospitals are dropping Medicare Advantage plans left and right, Beckers Hospital Review 12/14/23). Scripps Health based in California had cared for over 30,000 people in MA and recently notified their members that Scripps will no longer offer medical services to them unless they pay out of pocket or go back to real Medicare. Scripps made their decision because 75 million worth of services their physicians had recommended to their patients were turned down by MA! BTW Scripps provided the care and were stuck with the bill!

Likewise the Mayo Clinic has warned its customers in Arizona and Florida that they won’t be accepting Medicare Advantage anymore! ( Mayo Clinic warns it won’t Take Most Medicare Advantage Plans (Medpage Today- 10/20/2022). 

Complicit Politicians 

One plausible reason this National insurance fiasco is allowed to continue unchallenged is because of the amount of Politicians on the take from lucrative private insurance and systemically allowing them to shear the middle class. The Pew research center conducted a comprehensive research poll and unequivocally discovered that 70% of Americans felt the US economic system unfairly favors the economically powerful! Gandhi stated that the measure of a society is how it treats its weakest members. Many are realizing the American economic reality is just the antithesis of Gandhi’s vision. Ironically the American Public while voicing their sense of economic injustice miss corporate malfeasance and its collusion with the political parties. They have not remotely grasped the immense Elephant in the room theft by Medicare Advantage or how it works! It is pertinent to realize that over one third of congressional members hold significant health-care related financial assets while two thirds of congress members cashed Pharma campaign checks in 2020. (State news .com 6/9/21) 

Advertisement Deception 

A clear explanation of the exploitation can be traced directly to expensive hired Media deceptive and manipulative advertising for the misnamed MA! If you have been anywhere near a television or read newspapers and magazines you can recall a non-stop bombardment of the last few months of health insurance ads which were devised for the most part to transition Medicare members to MA. “Paid corporate marketing skews heavily toward the indoctrination of MA, which is more than twice as profitable for private insurers than any other type of coverage they offer. Incredibly 9 out of 10 TV ads that ran last fall explicitly focused on MA. (Kaiser Family Foundation 10/16/23). Reminiscent of gambling ads most of those ads featured celebrity spokespeople touting the plans supposed benefits”! ( Forbes 2/21/24). 

Personal experience 

As a retired educator for 30 years of service my health insurance during my career was always crucial to me especially with five children! I carefully monitored my coverage and at retirement in 2014 when I was 65 I enrolled in original Medicare and fully expected to remain there for life. By accident in 2024 in a phone conversation with the Michigan ORS I discovered that I was taken from Medicare in 2016 and placed in MA along with every state worker without any notification. I have since talked to other friends who worked at ATandT, unionized carpenters, and other private workers who experienced the same transition without any warning! The ORS, MEA, MARSP nor Democratic party were unable to explain to me why no notification was given to the state workers in this state! I met Senator Gary Peters at an Alma College football tailgate party last fall. We had friendly conversation as we are both Alma Alumni but when asked about the forced placement of retirees here in Michigan and nationwide into MA his expression changed pleading no knowledge of the situation. I asked what he thought of the privatization of any social program including Social Security, the Post Office, Public Schools or more specifically Medicare and did he recognize the conservative age long penchant to do just that. He also claimed to be unaware of the Democratic Mayor from NewYork Bill de Blasio who attempted to also switch hundreds of public workers to MA but got caught admitting he was just trying to save the city money! 

New York City the Perfect Prototype 

There is a stark contrast between the thousands of public workers in NewYork with those in Michigan as they experienced the same switch to MA! Amazingly the NewYorkers stormed city hall in protest, sued the city and won a ban by a New York Supreme justice to stop MA! The lack of protest here in Michigan or even cognizance to the issue is telltale and can be traced to a constipation of information not emanating from the Unions and the Democratic party which were traditional expected sources of help to workers. It is a historical fact that in July of 2023 hundreds of retired New York city workers physically stormed city hall and challenged the plan to change their health plan to MA! That secretive plan would have impacted over 250,000 municipal workers. “ A stunning move by the city with political help and corporate coaxing to change the health benefits of hundreds of thousands of retired workers has prompted them to claim they are being forced to accept an inferior and costly plan called Medicare Advantage that could bankrupt them in their golden years. ( New York CBS New York) In addition, thousands of angry emails flooded Mayor Bill de Blasio’s office such as the following: “ I am angry, I feel it is a betrayal, 30 year city worker William Shenton said! Shenton pointed out the real catalyst for the switch maintaining it was a nexus with the Mayor and city unions to save millions for both. Shenton’s wife Susan suffers from a chronic lung disease and discovered that MA would only pay for a fraction of his wife’s needed medicine. ( Irate retires inundate CBS2 with emails 10/14/21). Rose, a retired teacher’s email stated: I can no longer get the needed cancer treatment from my doctors quickly because the new MA program is requiring pre-authorization which delays my treatment by a week, if I can get it at all! It was a backroom deal in a smoky room fumed NY retiree Loraine Motola ( CBS NY). 

An actual ban to Medicare Advantage 

The organized protest in NY resulted in a Manhattan Supreme Court judge permanently banning the MA as a substitute insurance for NY city retirees. ( Judge permanently Bans NY City from executing Retire MA plan MMIT Network 8/17 /23). In his decision the judge Lyle Frank ordered the city “ permanently from requiring any City retirees, and their dependents from being removed from their current health plans, and from being required to enroll in any MA plan”.

Imagine an organized protest of that magnitude from NY happening here in Michigan. Would that not be an appropriate action for the MEA? Remember however that the Neoliberals in NY were able to push their privatized health initiative with the full agreement and support of the Municipal Labor Committee which consists of 102 public sector unions in NY and voted for the Medicare switch in March of 2021! The democratic party and sister unions evidently lose little sleep over any privatization! 

Is Anybody Fighting? 

Unfortunately there are few political leaders fighting against MA! Bravely there are a few and their actions are under-reported and obfuscated but their stance is nonetheless correct and 

should be supported and espoused! A dozen U.S. senators and 3 witnesses sharply criticized MA marketing schemes and lack of coverage during a finance committee hearing in October of 23. Recently Senators Markey, Warren, and Brown joined in urging HHS and CMS to protect Seniors, and hold insurance companies accountable for abuse in MA! Senator Mark Pocan may be the most aggressive advocate for Medicare continuance as he has challenged the legality of private Insurance companies selling a private plan pretending its Medicare. Such advocacy against Medicare’s enemies is scarce and the clock is close to midnight especially when reviewing the recently released conservative Project 2025. While conservatives have always been opposed to most social programs, they have stated unequivocally in Project 2025 their intentions to make MA the default enrollment option for all 65 year old retirees! Simply put, all seniors at 65 would automatically be placed into MA. No one doubts the Trump administration would enact the components of Project 2025 if re-elected! 

Anti-Social Program History 

G.W. Bush was just another run -of- the- mill right wing ideologue in a line of conservative anti social program politicians dating back to 1933 when the Social Security attacks began. However he had a specific crusade his entire political career which he boasted about endlessly. His forte was to end Social Security and Medicare! When Bush left office he claimed his greatest regret was not to have privatized Social Security! He knew he had privatized Medicare with no regrets. 

Ronald Regan, another member of the conservative litany changed his party affiliation from Democrat to Republican because of his repulsion for SS and Medicare. Republican Mike Lee vowed at a campaign rally in 2010 that he would phase out SS and Medicare and ranted he would pull them up by the roots and get rid of them. Today we have an undesirable union and bipartisan proclivity from both parties to favor wealthy corporate interests called neoliberalism. Regan ran on a Mantra of privatization and deregulation and today we see the battle lines with all remaining public institutions and social programs to supplant public with private! To fool us Bush signed an act which contained the MA scheme on December 8 2003 cleverly titled The Medicare Improvement and Modernization Act. Equally revealing he pretended to be concerned with the well-being of SS while telling his base he would end it! An example of his real Social Security appreciation manifested when he withdrew 1.37 trillion from SS to pay for his tax cuts for the rich and never repaid it! 

Stand and Fight 

Medicare was initiated on July 30 1965 and for 59 years has protected the health and welfare of millions of Americans. It has been estimated that just between 1999 and 2013, 300,000 American lives were saved by its existence. Life expectancy also increased by 5 years from its inception to 2018! One of the greatest social aspects of the program is that it was created for people over 65 regardless of income and medical history! The humane aspect of Medicare is its designated care for the elderly at their vulnerable age restoring personal health and dignity. It is difficult to comprehend how anyone could try to end a plan intended for the elderly and disabled offering help to those unable to afford the high cost of private coverage. We must stand against their damaging efforts to ensure the continuance of Medicare for our children and all Americans! 

Image used in this article is from Health Care For All-Washington