What’s supposed to be simple health insurance coverage for America’s retirees has ballooned into a complex, debt-inducing array of private “Advantage” plans.
For the uninitiated, it sounds nonsensical: outlandish levels of medical debt for America’s elderly, despite a popular Medicare program designed to provide basic healthcare coverage to every retiree. And yet America’s seniors are dealing with $50 billion in unpaid medical bills. A Wisconsin congressman points to so-called Medicare Advantage plans, where the advantage appears to be with private insurance company profits rather than consumer “choice.”
“Medicare Advantage is a private insurance alternative to Medicare that is a case study on how lobbyists work in Washington,” US Rep. Mark Pocan (D-Black Earth) told UpNorthNews Radio. “They crafted a bill that couldn’t have been more profitable for private industry, for insurance companies. It’s directly taking on one of the most popular services that [the federal government] provides, Medicare, and threatening it.”
An estimated 31 million Americans have purchased Medicare Advantage plans after seeing an endless parade of television ads from private insurance companies claiming their plans will cover extra services not found in basic Medicare. The advertising works—a little more than half of Americans on Medicare have opted to purchase a private plan.
The result? According to the Consumer Financial Protection Bureau (CFPB), despite 98 percent of adults age 65 and older having health insurance coverage, nearly 4 million of them have unpaid medical bills—even though 70 percent of that group reports having two or more insurance plans. As of 2020, the CFPB calculated $53.8 billion in unpaid medical bills for America’s elderly—for whom Medicare was written as a way to escape poverty from the health problems of aging.
Complaints range from overbilling to complex policy language, onerous requests for pre-approval, and denial of reimbursement to many providers, frequently in rural areas.
“Just in overbilling alone for Medicare Advantage companies, it was $140 billion the last time we kept track of that,” said Pocan. “That is enough to cover Medigap insurance for every single person on Medicare or to extend dental vision and hearing to every single person on Medicare. And that’s just where they’re ripping us off, much less the prior authorizations they also require.”
Critics say the prior authorization requirement is a way to protect profits rather than anything rooted in medical science. Pocan said when seniors appeal a denial of coverage, they win about 85 percent of the time.
“But delayed care is often death,” Pocan said, “when you’re part of that population.”
Pocan and other senior advocates say a reliable resource can often be found in a local courthouse, at your county’s Office on Aging—where experts can offer guidance without the sales pressure that can come from calling a private insurance company. The Wisconsin Office of the Commissioner of Insurance also has a 17-page Consumer’s Guide to Medicare Advantage in Wisconsin that can be seen online as a pdf.
