"I'm Getting Screwed!" : Medicare Advantage is Not Medicare, It's Private Insurance

“I’m Getting Screwed”: It Happens Much More Than You Think

A couple of months ago I was at a speaking engagement with a panel discussing universal healthcare and literally, the fifty different ways we could implement a single payer system that would work infinitely better than we have now. And, no it is not socialism. No, we won’t have longer lines because we will have the same healthcare providers, just better ability to receive care. While seventy percent of the nation wants a single payer systems (Republicans, Dems and Indies agree across dozens of surveys and studies), we still have folks who don’t understand a single payer system would use all of our existing systems, but more efficiently, receive higher quality care and costs would be lowered. Period. Not perfect at all but much better than we have.

After the panel discussion, two women approached me tentatively who clearly had a bone to pick with me. I asked them to come over and chat. The older of the two said, with conviction: “I’m getting screwed and you are helping the devil.” I said jokingly, “Well, I’ve never worked with the devil but I hear he is trouble.” She was not amused.

We got into it. “That Medicare Part C is the devil. They say they will provide coverage and don’t. Then my deductible skyrocketed. I have Macular Degeneration and still don’t have vision coverage. Nobody seems to care.” Her daughter, said the Part C folks never answered, lied to her on the phone and she was exhausted from trying to get them to help. I gave her some ideas and a consumer help referral along with some AARP contacts.

Before I helped them with their specific problem, I said with animation:
“MEDICARE PART C IS NOT MEDICARE. IT IS PRIVATE INSURANCE. THEY ONLY CARE ABOUT YOUR MONEY, NOT YOU.”

Their mouths sat agape. Further, they could not believe how convincing the private insurers’ marketing was. I responded with “yes, absolutely.” These private insurers need guardrails, so they cannot take advantage of older folks and the disabled community.

I went on to explain how it works (many of you completely understand this, but many don’t)…

What Is Medicare?
Medicare is a federal health insurance program primarily for people age 65 and older, as well as certain younger individuals with disabilities. It consists of two main parts:

• Part A (Hospital Insurance): Covers inpatient hospital stays, nursing facilities, hospice, and some home health services.
• Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and other outpatient treatments.

These two parts are often referred to as “Original Medicare.”

What Is Medicare Advantage?
Medicare Advantage (Part C) is a private insurance plan approved by Medicare. It offers an alternative way to receive your Medicare benefits. Instead of enrolling directly in Part A and Part B, beneficiaries choose a Medicare Advantage plan offered by a private insurance company. These plans often include additional benefits, such as vision, dental, and hearing coverage, and sometimes include prescription drug coverage (Part D).

How Private Insurance Is Taking Advantage of People on Medicare
Medicare was created to provide seniors and certain disabled individuals with affordable health coverage, ensuring they receive the care they need without excessive costs. However, as private insurance companies increasingly become involved through programs like Medicare Advantage, concerns have arisen about whether these companies are taking advantage of Medicare beneficiaries for profit.

The Rise of Medicare Advantage
Medicare Advantage (Part C) plans are offered by private insurers authorized by Medicare. These plans often promise extra benefits, such as dental, vision, hearing, and prescription drug coverage, which can be attractive to beneficiaries. But while they expand options, they also introduce issues of concern.

Profit Motives vs. Beneficiaries’ Needs
Private insurance companies participating in Medicare Advantage are driven by profit. They receive a fixed payment from the federal government for each enrollee, regardless of the cost of care. This creates incentives to minimize payouts, sometimes at the expense of patient care.
Several practices suggest that some private insurers are exploiting this structure:

• Restricting Access to Care: Many Medicare Advantage plans impose narrow networks of providers, making it harder for beneficiaries to see their preferred doctors or hospitals. This limits choices and can lead to delays in care.
• Reducing Covered Services: To cut costs, some plans limit coverage for needed treatments or medications. Beneficiaries might face high co-payments or outright denial of certain services.
• Overbilling the Government: There have been investigations and lawsuits claiming that some insurance companies inflate their costs or submit false claims to receive higher payments from Medicare, increasing taxpayer burden.
• Misleading Marketing Practices: Certain private plans advertise benefits that sound appealing but are difficult to access or legally limited. Some beneficiaries enroll expecting certain services, only to find they are not covered or inaccessible.

Impact on Beneficiaries
Many beneficiaries, trusting their plans, may not be aware of the games some private insurers are playing. They might experience:

• Higher out-of-pocket costs
• Reduced access to preferred providers
• Loss of certain benefits
• Delays or denials of essential medical treatments

This can lead to deteriorating health and increased financial strain on already vulnerable populations.

What Can Be Done? Accountability and Regulation Challenges
To protect beneficiaries, it is crucial for regulators, policymakers, and Congress to scrutinize these practices, enforce transparency, and ensure that private insurance and Medicare continue to serve its original purpose: providing affordable, comprehensive healthcare to those who need it most.
Getting Help For Your Individual Issues
1. State Health Insurance Assistance Programs: SHIPs are state-based programs funded by the federal government to help you get the care you need.

• They offer free, unbiased counseling and assistance to Medicare beneficiaries, their families, and caregivers. https://www.shiphelp.org/
• AARP: https://www.aarp.org/homepage/...

CALL TO ACTION: Demand Accountability For Private Insurers in Medicare Advantage

• Call Republican senators: Recent Medicaid cuts will affect long term care, some types of Medicare funding and more. Ask them how you might be affected and what to do. This is a great list of folks to call about private insurance and their lack of accountability:
  • https://www.senate.gov/senator...
• Call Republican members of Congress: The same holds for these congressional members:
  • https://www.gop.gov/about/memb...