The Spark

the Voice of
The Communist League of Revolutionary Workers–Internationalist

“The emancipation of the working class will only be achieved by the working class itself.”
— Karl Marx

Medicare Advantage Is a Disadvantage

Dec 5, 2022

This year, half of all seniors in the U.S. will have chosen a Medicare so-called Advantage plan rather than a Medicare supplemental plan. These plans are heavily advertised on TV and by mail, and the ads stress that the plans pay for dentures and hearing aids. (Medicare was designed and passed by Congress in 1965 without dental or hearing aid coverage.) The so-called Advantage plans’ premiums are lower than supplemental Medicare plans, which helps many seniors who lack pensions.

The catch, in this capitalist society, is that these plans turn down almost one of every five claims. The ads for these disadvantage plans never mention that, nor the fat profits they make for the five largest healthcare insurers in the country, with million-dollar salaries for their CEOs. They are known to turn down the doctor or surgeon chosen by the patient, the treatment proposed and the rehab required.

The senior, on a limited budget, in a wheelchair, needing dialysis, will be turned down for transportation coverage to get to where these plans send patients. The money saved in lower premiums will be wiped out when care is really needed and the so-called advantage plan does not pay.

In addition, every government agency or business or corporation covering the healthcare of retirees is charged more for Medicare Advantage claims. This overcharge comes to billions of dollars, according to the New York Times, which recently reported NASA was overcharged by 20 billion dollars and the FBI by close to 10 billion dollars, and so on for many other government agencies.

The disadvantage plans cost ALL taxpayers extra money, because these healthcare racketeers charge more per patient to the federal government for reimbursement than do Medicare providers. Again, they get away with it thanks to lobbying politicians. When these plans began 20 years ago, they immediately charged the Medicare Trust Fund more money than did regular Medicare. The CMS, the Center for Medicare and Medicaid, already knew by 2009 about some of the dirty tricks used by insurers such as Aetna, Cigna, United Healthcare and Kaiser. A medical analyst pointed out, "even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care."

These insurers pressured doctors and nurses to find more diagnoses per patient in order to charge more to the fund; they would reward doctors and nurses for stating that patients were sicker; they sent out providers to diagnose people at home with cancer, which is impossible. And for such practices, a few lawsuits cost these companies a couple million dollars in fines. These are the consequences of making healthcare a for-profit business.