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10 Reasons Medicare Advantage Plans Will Never Meet Our Needs

A robust national health insurance program should put people before profits

With Medicare for All, there would be no need for Medicare Advantage plans. (Photo: National Nurses United/flickr/cc)

With Medicare for All, there would be no need for Medicare Advantage plans. (Photo: National Nurses United/flickr/cc)

More and more policymakers and Americans are recognizing the value of Medicare for All, a national health insurance program run by the government on behalf of its citizens. But there is still some confusion about the role commercial insurers might play in such a system.

Some argue that commercial insurance companies could be a part of Medicare for All, in much the same way that commercial “Medicare Advantage” plans function in today’s Medicare. That’s why it is important to understand the difference between traditional Medicare and Medicare Advantage plans, and why Medicare Advantage plans will never meet our needs.

While Medicare Advantage plans are far more heavily regulated than commercial insurance in the private sector, they still have all of the core failings of commercial insurance—for individuals, for taxpayers and for the public good.

  1. Restricted choice: Medicare Advantage plans limit the doctors and hospitals enrollees can use and generally have little incentive to include providers who deliver value in their networks. They generally do not compete with one another to meet the needs of Americans who need costly care. For this reason, sicker people are more likely to disenroll from them.

  2. Meaningless choice: Medicare Advantage plans do not offer people information that would allow them to understand what they will pay out of pocket when they need costly care and which doctors and hospitals they will be able to use.

  3. Care rationing based on ability to pay: Medicare Advantage plans shift costs to people most needing care; high deductibles, copays and an out-of-pocket cap of nearly $7,000 each year undermine access and ration people’s care based on their ability to pay.

  4. Unreliable coverage: Medicare Advantage plans cannot offer reliable coverage or continuity of care as they are constantly changing the products and services they offer, the providers in their network, as well as their enrollees’ cost-sharing obligations. And, at times, they are pulling out of the market altogether.

  5. Ever-increasing costs: Medicare Advantage plans cannot rein in costs or slow down the rate of growth in health care spending.

  6. High administrative costs: Medicare Advantage plans drive up costs through the time, money and personnel they require for billing and other insurance-related administrative activities.

  7. Profits before people: With a few notable exceptions such as Kaiser, Intermountain and Geisinger, Medicare Advantage plans are obligated to put shareholders first, with incentives to maximize profits. A recent HHS report by the Office of the Inspector General reveals their widespread wrongful denials of medically necessary care.

  8. No innovation for the public good: Medicare Advantage plans have no incentive to innovate for the public good or disclose information about medical protocols, devices and other treatments that would benefit the public at large. What they learn about what’s working and not working in our health care system, they tend to keep to themselves.

  9. Little transparency: Medicare Advantage plans treat much of their operations as proprietary, preventing needed oversight and public understanding of areas where they are failing consumers.

  10. Little accountability: Medicare Advantage plans may engage in fraudulent and illegal behavior. The federal government cannot always oversee them effectively and hold them accountable for inappropriate behavior, let alone illegal activities.

With Medicare for All, there would be no need for Medicare Advantage plans. Everyone would have an improved and expanded Medicare, with freedom to use the doctors and hospitals of their choice anywhere in the nation and without premiums, deductibles and copays.

If you support Medicare for All, please let your members of Congress know. Sign this petition.

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Diane Archer

Diane Archer is president of Just Care USA, an independent digital hub covering health and financial issues facing boomers and their families and promoting policy solutions. She is the past board chair of Consumer Reports and serves on the Brown University School of Public Health Advisory Board. Ms. Archer began her career in health advocacy in 1989 as founder and president of the Medicare Rights Center, a national organization dedicated to ensuring that older and disabled Americans get the health care they need. She served as director, Health Care for All Project, Institute for America’s Future, between 2005 and 2010.

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