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medicare advantage
A $1.2 Trillion ‘Rip Off’: Report Spotlights Massive Scale of Medicare Advantage Fraud
"These private insurer-run plans are more expensive AND lead to worse outcomes for patients," said Rep. Pramila Jayapal. "It’s time to rein in Medicare DisAdvantage and protect traditional Medicare."
Jan 28, 2026
A report released earlier this month to little fanfare estimated that federal overpayments to privately run Medicare Advantage plans could total $76 billion this year—or potentially a staggering $1.2 trillion over the next decade if current trends persist.
The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises lawmakers on Medicare, calculates overpayments by comparing spending on Medicare Advantage (MA) plans to what the federal government would have spent if MA enrollees were on traditional fee-for-service Medicare.
In a report published earlier this month, MedPAC showed that overpayments to MA plans this year are projected to be around $76 billion. Roughly $22 billion of that total is due to coding practices by MA providers, which are notorious for making patients appear sicker than they are to receive larger payments from the federal government. MA plans are paid lump sums to cover expected future healthcare services for patients based on their risk scores.
Another factor driving overpayments to MA plans—which now cover 55% of eligible Medicare beneficiaries—is a phenomenon known as favorable selection. MA enrollees tend to be healthier on average than recipients of traditional Medicare, resulting in higher payments to Medicare Advantage plans than are necessary based on patients' healthcare needs.
According to MedPAC, favorable selection will account for $57 billion of the expected overpayments to MA plans this year. The Trump administration gave Medicare Advantage plans a more than $25 billion boost in federal payments for 2026, even amid mounting bipartisan concerns about fraud in the program.
The National Committee to Preserve Social Security and Medicare (NCPSSM) said the MedPAC analysis "confirms that these private plans are bleeding taxpayers for billions of dollars more than traditional Medicare would cost for comparable enrollees."
US Rep. Pramila Jayapal (D-Wash.) wrote in response to the MedPAC findings that "Medicare DisAdvantage will rip off American taxpayers to the tune of $76 billion in 2026."
"These private insurer-run plans are more expensive AND lead to worse outcomes for patients," Jayapal, a leading supporter of Medicare for All legislation in the House, wrote in a social media post. "It’s time to rein in Medicare DisAdvantage and protect traditional Medicare."
The MedPAC analysis was released days after Republicans on the Senate Judiciary Committee published a report revealing how UnitedHealth Group, the largest provider of MA plans in the US, "has turned risk adjustment into a major profit-centered strategy," reaping massive payments from the federal government through upcoding.
NCPSSM noted that "while UnitedHealth... has emerged as the worst offender, it’s abundantly clear that many MA insurers are engaged in these shady practices."
"Look no further than insurers’ reliance on prior authorizations for procedures and treatments that normally would be automatically covered in traditional Medicare," the group said. "This includes denying skilled nursing care that jeopardizes older patients who have nowhere else to turn."
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Trump's Health Plan Is Doomed to Fail—We Need Medicare for All
Unsurprisingly, Trump’s concepts of a plan don't even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care Act in order to fund tax cuts for billionaires.
Jan 17, 2026
President Donald Trump’s new “Great Health Care Plan” is anything but.
Unsurprisingly, Trump’s concepts of a plan fail to even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care Act in order to fund tax cuts for billionaires. Now, Trump and his Republican allies are trying to cover up the gaping wound they have created with a Band-Aid. At the same time, Americans are desperate for relief from Trumpflation, including rapidly rising healthcare costs.
Too many Americans struggle to get the healthcare they need even with insurance. A recent poll found that more than 1-in-3 adults in the US had skipped or postponed needed healthcare in the last 12 months because they couldn’t afford the cost. The situation is even more dire for the uninsured, with 75% of uninsured adults under age 65 reporting going without needed care because of the cost.
Shutdown negotiations and subsequent scattershot health ideas from the White House and Republicans in Congress show they have no real idea what to do when it comes to actually bringing down the cost of healthcare in America. President Trump’s half-baked plan appears doomed to fail and doesn’t even have the support of Republicans in Congress. Plus the only alternate Republican plans for healthcare that currently exist strictly serve corporations and fail to provide relief to patients.
Every other comparably wealthy country has some version of universal healthcare, and none of them would trade their systems for the wasteful and haphazard US system.
Meanwhile, the Trump administration has undertaken efforts to further privatize Medicare, including adding Medicare Advantage-style prior authorization to traditional Medicare, risking access to care for seniors by delaying and denying needed care. It also plans to place Medicare enrollees in private health contracts, similar to Medicare Advantage, where the corporations in charge are incentivized to place corporate profits ahead of patient needs.
Americans are angry about our broken healthcare system, and they want a comprehensive solution. One recent survey found that 65% of voters support a Medicare for All-style system. A similar number of voters said that the federal government right now does too little to ensure Americans can afford the healthcare they need. An in-depth study that looked across four years of data found that more than a quarter of adults went without needed care or experienced cost burdens for care they did receive over the four-year period of the study. The high cost of care and limited coverage leaves tens of millions of Americans without adequate coverage, and millions of them end up saddled with medical debt, something unheard of in other comparably wealthy countries. We need to take bold but commonsense action to finally guarantee that everyone in the US can get the healthcare they need.
Providers and hospitals are also desperate for reform. The cost of doing business in our broken healthcare system is causing hospitals to close or shutter crucial services. Providers are facing huge challenges as greedy profiteers, including private equity companies, gobble up their hospitals and medical practices and impose cost-cutting measures in the service of maximizing profits.
Fortunately, Medicare for All would address all of these issues and finally put the health of Americans ahead of corporate profits. Medicare for All would guarantee that everyone in the US can get the care they need when they need it, without financial barriers or hoops to jump through, and would be cheaper than our current system while providing coverage that is better than any commercial health insurance plan. It would do this by taking Medicare—one of the most popular parts of our healthcare system—improving it by expanding available services, ending out-of-pocket costs, and expanding it to everyone in the country.
Corporations and certain members of Congress purposefully make such a commonsense system sound like an impossible leap from America’s current broken system in order to stifle American dissatisfaction with our healthcare and keep shareholders happy. But every other comparably wealthy country has some version of universal healthcare, and none of them would trade their systems for the wasteful and haphazard US system.
We continue to see more members of Congress signing on to support Medicare for All in both the House and the Senate, and more municipalities supporting resolutions in favor of Congress passing Medicare for All. The time has come to unite around Medicare for All and build the movement that can finally make it a reality.
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Medicare Advantage, Privatized Medicaid Could Cost Americans $2 Trillion Extra Over Next Decade
"If the administration were serious about curbing waste and inefficiency, it would start by reducing the diversion of public funds to these corporate intermediaries," argues a new paper.
Nov 07, 2025
US President Donald Trump and his Republican allies in Congress took a sledgehammer to Medicaid over the summer, justifying the unprecedented cuts by falsely claiming the program that provides health coverage to tens of millions of low-income Americans is overrun with waste and abuse.
But a new paper published Friday in the journal Health Affairs argues that if the administration actually wanted to target waste, fraud, and abuse, it would have been much better off taking aim at Medicare Advantage (MA) and Medicaid privatization.
The paper's authors estimate that overpayments to MA plans—which are funded by the government and run by for-profit insurers—and private Medicaid managed care will likely cost US taxpayers a total of $1.92 trillion over the next 10 years.
"Ending that waste would inflict losses on private insurers' shareholders and executives (the CEO of the largest MA firm made $26.3 million last year). But patients, not just government coffers, might gain," wrote Adam Gaffney, Danny McCormick, Steffie Woolhandler, and David Himmelstein.
"Even Congress' trillion-dollar cuts to Medicaid and food assistance amount to little more than half of the potential savings from de-privatizing Medicaid and Medicare," they added. "Reclaiming those funds would require reversing the decades-long trend of outsourcing to profit-seeking intermediaries and restoring Medicare and Medicaid as efficiently administered public programs."
Far from aggressively taking on Medicare Advantage fraud, the Trump administration handed MA plans a major gift earlier this year by approving an average federal payment increase of roughly 5.1%—more than double the 2.2% increase proposed by the Biden administration in January.
The authors of the new paper noted that the huge raise for MA plans, which are notorious for denying necessary care in pursuit of ever-larger profits, will add $25 billion in waste to the US healthcare system next year alone.
"If the administration were serious about curbing waste and inefficiency," they wrote, "it would start by reducing the diversion of public funds to these corporate intermediaries."
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