Medicare Advantage Is Neither Medicare Nor an Advantage

by | Feb 1, 2023 | Admin

by Wendell Potter

Medicare Advantage is a money-making scam. I should know. I helped to sell it.

Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.

But here is the truth: Medicare Advantage is neither Medicare nor an advantage.

And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.

During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare — real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits — at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.

Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems… Congress should work to lower the cost of health care.

 

Apology and Accusation

I regret my participation in those efforts. Over the 20 years since Congress passed the Medicare Modernization Act, the Medicare Advantage program has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits. As Kaiser Health News reported last month, the Center for Medicare and Medicaid Services estimated “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses at $11.4 billion for 2022.” That was for just one year. Imagine what the cumulative historical total would be.

The Medicare and Medicaid programs have become so lucrative and profitable for insurers that UnitedHealth Group, the nation’s largest health insurer and the biggest in terms of Medicare Advantage enrollment, got 72 percent of its health plan revenues in 2021 from taxpayers and seniors. In fact, all of UnitedHealth’s enrollment growth since 2012 has been in government programs. Enrollment in the company’s employer and individual health plans shrank by 370,000 between September 30, 2012, and September 30, 2022. Much of the $81 billion UnitedHealth collected in revenues in the third quarter of last year was subsidized by American tax dollars.

Members of Congress on both sides of the political aisle – and both sides of the Capitol – are at long last calling for more scrutiny of the Medicare Advantage program. Sen. Chuck Grassley has called for aggressive oversight of Medicare Advantage plans to recoup overcharges and was quoted in the Kaiser Health News story. As was Sen. Sherrod Brown, who said that fixing Medicare Advantage is not a partisan issue. As Rep. Katie Porter commented, “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

I know that Democrats and Republicans alike care about the financial stability of the Medicare program. Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems, and in the process helping Big Insurance make massive profits, Congress should work to lower the cost of health care.

Medicare Advantage is a money-making scam. I should know. I helped to sell it. And I am going to continue working alongside patients, caregivers, and elected officials to address the problems.

 

Wendell Potter is the former vice president for corporate communications at Cigna. He is now president of “Business for Medicare for All” and author of bestselling books Deadly Spin and Nation on the Take.

commondreams.org/author/wendell-potter

 

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Common Dreams.org. Reprinted by permission in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

Insurance Industry Insider Instructs Providers

by | Sep 16, 2020 | CMS, Editorial

Insurance Industry Insider Instructs Providers

September 16, 2020

by Wendell Potter

(Adapted with permission from an article posted on the author’s Twitter feed. –Editor)

Wendell PotterMy former colleagues in the health insurance industry claim they are waiving all costs of testing and treatment for COVID-19. This is a lie.

I will explain the reality that this promise does not apply to everyone, in fact to a fraction of covered lives, and there is no enforcement mechanism to ensure that it will. Here is the truth: When insurers and the Trump administration say insurers are “doing their part” to end the pandemic, they are counting on Americans to be fooled by industry lingo, to believe that COVID-19 health expenses are covered. When I worked as VP of PR for Cigna, I would have gotten a bonus for achieving this deception.

In reality, this is world-class propaganda on display. To see how the industry is pulling the wool over our eyes, go to the website of its trade group, AHIP (America’s Health Insurance Plans). It is, intentionally, close to impossible to follow what each insurance company is actually doing.

A secret: The main purpose of insurers’ web sites and documents is to provide a space to crow about their “charitable” donations, which are a tiny percentage of their revenues. I know firsthand! One of my roles at Cigna was to head the company’s meagerly-endowed foundation.

An example: To see how they mislead regarding actual COVID-19 costs, let’s examine the hidden caveat in one company’s claim. Aetna says it

“will waive co-pays for all diagnostic testing related to COVID-19… That includes all member costs associated with diagnostic testing for Commercial, Medicare, and Medicaid lines of business. Self-insured plan sponsors will be able to opt-out at their discretion. Aetna is also offering zero co-pay telemedicine visits for any reason, and extending [additional benefits] to all fully insured members.” 1

Notice the catch? They mention “self-insured” plan sponsors. Nearly 80% of Aetna’s health plan members are in these types of plans. If you get your coverage through your employer, you likely are one of them. Aetna does not consider these people “fully insured.” Therefore, their promises may only apply to 20 percent of their members.

Of course, most folks probably have no idea whether they are in a “fully insured” or “self-insured” plan, but it makes a world of difference, especially during this pandemic. And believe me, these companies are thrilled by your confusion. It could save them millions.

Maybe we should expect private insurers to be dishonest by now, or rely on government watchdogs to take care of us. That is the other problem. There is no watchdog at any level of government monitoring this deceptive practice. In other words, there are no consequences to insurer deceit. And they know it. Again, I know it because I used to be one of them.

The answer? All insurers should be required to state exactly what percentage of their members actually benefit from their “promise” to fully cover COVID-19 testing and treatment. And Congress should look into this ASAP.  It would be a great chance for Representative Katie Porter (D-CA) to embarrass the insurers yet again.2

Wendell Potter is a former insurance industry PR executive and the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans” and “Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It,” both published by Bloomsbury Press. He is the founder of Tarbell™ a non-partisan news publication of To Be Fair, Inc., an IRS-approved 501(c)3 non-profit organization. He also serves as senior analyst at the Center for Public Integrity, one of the nation’s oldest non-partisan, nonprofit investigative news organizations, and is a contributor to The Huffington Post and healthinsurance.org. His work has also appeared in Newsweek, The Nation and The Guardian.