Latest News on the Medicare Advantage Program

Democrats introduce bill to rename Medicare Advantage

In an effort to crack down on deceptive practices by Medicare Advantage providers, Democratic Reps. Mark Pocan, Ro Khanna and Jan Schakowsky reintroduced legislation on Tuesday that would ban private insurers from using the label “Medicare” in their plan names. Health.

The legislation, titled the Save Medicare Act, would formally change the name of the Medicare Advantage program to the Private Alternative Health Plan, an attempt to make it clear to seniors that the plans are run by private entities such as Anthem, Humana, Cigna and UnitedHealthcare.

“Medicare is just Medicare,” Pocan (D-Wis.) said in a statement. “It’s one of the most popular and important services the government provides. These non-Medicare plans run by private insurers undermine traditional Medicare. They often leave patients without the benefits they need while charging the federal government for corporate profits.”

Khanna (D-Calif.) declared that “it’s time to call out ‘Medicare Advantage’ for what it is: private insurance that profits by denying coverage and the name is used to trick seniors into signing up.”

“This is not right,” he added. “This bill will end the scam by preventing private insurers from profiting off the Medicare brand. Our focus should be on strengthening and expanding real Medicare.”

The bill, which faces long odds in the Republican-controlled House, was introduced as GOP lawmakers push to cut traditional Medicare as part of their broader austerity campaign.

It also comes as the Biden administration is moving forward with a Medicare privatization scheme known as ACO REACH, a pilot program that critics warn could completely upend traditional Medicare in a matter of years.

The Democratic trio’s legislation does not specifically address ACO REACH, choosing instead to focus on Medicare Advantage plans that are notorious for denying needed care to vulnerable seniors and overbilling the federal government.

The measure would impose a $100,000 penalty each time a private insurer uses the Medicare name in the title of one of its plans.

“The so-called Medicare Advantage is neither Medicare nor an advantage. It is simply another scheme for insurance companies to line their pockets.”

Earlier this week, the Biden administration proposed a new rule that would strengthen audits of Medicare Advantage plans, which the federal government pays an annual per-person fee. Recent research has exposed how Medicare Advantage plans often overburden the government by making patients appear sicker than they are, resulting in higher payouts.

The federal government currently expects to pay Medicare Advantage providers more than $6 trillion over the next eight years.

“Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that calculates higher rates for sicker patients and lower rates for healthier people,” Kaiser Health News reported in December. “But federal officials rarely ask for documentation to verify that patients have these conditions, or that they are as severe as claimed. Only about 5 percent of Medicare Advantage plans are audited annually.”

Medicare Advantage has grown rapidly over the past decade, with more than 28 million people in the US enrolled in these plans as of 2022. MA plans often offer coverage for hearing, vision, and dental benefits that it does not Traditional Medicare, despite efforts. of progressive lawmakers to expand the program.

Some Democratic lawmakers have warned that part of the massive growth rate of Medicare Advantage plans could be due to their deceptive advertising practices.

In November, Senate Finance Committee Chairman Ron Wyden (D-Ore.) released an investigative report that presented evidence of a series of predatory actions by private insurance companies that offer plans Medicare Advantage.

“Agents have been found to enroll plan beneficiaries under false pretenses, such as telling a beneficiary that coverage networks include preferred providers even when they do not,” the investigation found. “Of particular concern to the committee were reports of agents changing the health plans of vulnerable seniors and people with disabilities without their consent.”

Wendell Potter, president of the Center for Health and Democracy, said Tuesday that “the so-called Medicare Advantage is neither Medicare nor an advantage.”

“It’s simply another scheme by insurance companies to line their pockets at the expense of consumers,” said Potter, a former health insurance executive with firsthand experience of the industry’s deceptive practices. “I applaud Congressman Pocan and Congressman Khanna for introducing this vital legislation. The health care marketplace is confusing for consumers and misleading branding like so-called Medicare Advantage only makes it worse.”

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