The federal government will soon announce its payment rates and policy changes for the Medicare Advantage program. Here's how you can influence their decision.

In the coming days, the federal government will announce whether big health insurers that run the private Medicare Advantage program will receive billions more of taxpayer dollars in 2025.

Two things today:

The story we published yesterday about how big insurers are pressuring the Center for Medicare and Medicaid Services to give them a big raise next year included a long list of news reports over the past year about the many disadvantages of Medicare Advantage, not just to seniors and disabled Americans but also to health care providers and taxpayers. 

1. We suggested you “call the White House”– not to carry water for big insurers, as they asked Americans to do in their Super Bowl ad last year–but to express your outrage and insist on major reforms to Medicare Advantage. We hope you’ll consider calling and writing the White House–and your members of Congress–to demand an end to the money grab that is called Medicare Advantage. Some of you said you’d do that and asked for talking points. Below you’ll find some for your consideration.

2. We limited our list of media stories to two a month that have appeared just over the past 12 months. We could have listed hundreds. Many good ones, including those that reach business leaders and investors, weren’t included. Here are three, from Bloomberg, you should know about. They’re behind a paywall, but you’ll get the gist from just the headlines.

   • Major Insurers Are Scamming Billions from Medicare, Whistle-Blowers Say: Billing for illnesses that don’t exist, like prostate cancer in a woman.
     Bloomberg | John Tozzi, April 12, 2022

   • The Hunt for the Riskiest, Most Lucrative Patients: Privately run Medicare Advantage programs are squeezing money from the Medicare risk-adjustment system by coding sicknesses for maximum payout.
     Bloomberg | John Tozzi, October 13, 2021

   • Insurers Gaming Medicare Might Cost Washington Billions a Year: Health plans get paid more for covering sicker patients. Are they exaggerating how ill people really are?
     Bloomberg | John Tozzi, June 23, 2015

As for talking points to use when you call the White House and Congress, below are a few for your consideration. This link provides information on how to reach the White House. This link will help you get in touch with members of the House of Representatives, and this one will help you reach your senators.  

• I’m reaching out to tell you how upset I am about my tax dollars being wasted on Medicare Advantage, which for me and many other Americans is a big disadvantage.

• Instead of lowering the costs of care for people eligible for traditional Medicare, the program has never saved taxpayers a dime. In fact, Medicare Advantage is costing me and other taxpayers significantly more, and it provides inconsistent access to quality care for those who need it most.

• Most Medicare Advantage plans are operated by big for-profit insurers that overbill taxpayers by up to $140 billion per year. That’s enough money to cover dental, hearing, and vision not only for ALL Medicare beneficiaries but also for people enrolled in Medicaid–AND reduce out-of-pocket expenses for Medicare beneficiaries to no more than $5,000 a year.

  

• Most Medicare Advantage plans have highly limited networks. 35% of Medicare Advantage enrollees are in plans that cover fewer than 30% of physicians in their county. This disproportionately affects rural communities.

• Because of those limited networks and denied or delayed care, health outcomes for people in Medicare Advantage plans are often worse than for those in traditional Medicare. As just one example,  a study from the Journal of Clinical Oncology found that cancer patients in Medicare Advantage plans had to wait longer for their cancer surgery and were far less likely to get cancer surgery at a Center of Excellence. They also had significantly higher post-op mortality rates.

• The marketing of Medicare Advantage plans is often deceiving and preys on vulnerable seniors. The US Senate Committee on Finance released a report in 2022 outlining the deceptive and fraudulent practices involved in recruiting seniors to these plans.

• Just as outrageous is the fact that  8 out of the 10 biggest Medicare Advantage insurers have submitted inflated claims to boost profits. Four of the biggest five have faced federal lawsuits for fraudulent claims.

• In the coming days, CMS will announce how much more of our tax dollars will go to big insurers that market these hugely profitable plans next year. I’m asking you to tell CMS not to give those companies a raise and to get serious about ending this money grab.

• This is urgent. The government is enriching a few corporate executives and shareholders with money that should be used to improve traditional Medicare. If you don’t act soon, traditional Medicare will disappear as an option for our most vulnerable citizens, and the executives and shareholders that prey on them will get even richer–with our tax dollars.