Madeline,

More than 62 million people across the country rely on Medicare for their health care, and nearly half of those recipients are enrolled in Medicare Advantage, an alternative to traditional Medicare coverage for seniors through private health insurance companies¹. Funds from the traditional Medicare trust are used to pay the health insurance companies offering Medicare Advantage plans -- and because these companies are private, their focus is ultimately on their bottom line. 

Over time, Medicare Advantage companies have committed widespread fraud, put patients’ care and lives in peril by denying their claims, and threatened the solvency of Medicare. It’s time for the Center for Medicare and Medicaid Services (CMS) to step up and stop the swindling.

The federal government is considering an important rule change that would allow CMS to better regulate these companies and is soliciting the public to leave formal comments about this proposed change by Friday, January 5, 2024. By sending in a flood of comments calling on CMS to do everything in its power to stand up for America's seniors and rein in the Medicare Advantage fraudsters, we can show the government that this issue matters.

If you believe that people should not have to worry about being ripped off while seeking health care, we need you to submit your comment today. Read on for more details on the problems with Medicare Advantage, how changing the rules can help CMS solve them, and how you can take action -- or if you’re ready to leave your comment, click here to submit it through the Office of the Federal Register's website now.

The main issues: Fraud, Denial of Care & Profiteering

Medicare Advantage (MA) has a track record of predatory marketing. Their misleading and aggressive advertising is not fully honest about what plans cover and what is available locally. Much of the advertising conveniently leaves out that MA plans often have restricted provider pools, high deductibles, and many of the promised services are not locally available. 

For those enrolled in Medicare Advantage, it can be difficult to get care without experiencing burdensome denials and delays. MA has a problematic pattern of denying upwards of 18% of all claims, even those that would be approved by traditional Medicare². Medicare Advantage enrollees and their providers should not have to jump through more prior authorization hoops than traditional Medicare participants. And these excessive denials and delays impact providers’ participation in the program: there is a recent trend of rural hospitals no longer accepting Medicare Advantage insurance because of the burden of the preauthorization process and denials³. Losing rural providers would put many in the state at risk of losing access to care.

Finally, we need to address the rampant profiteering being committed by these companies. The Medicare program is nothing short of a lifeline for millions of Americans, and we know that its financial stability is more perilous than ever. Yet, insurance companies through MA are draining the trust fund by taking taxpayer money to pay their agents and brokers outrageous bonuses and fund their deceptive advertising (the ads alone are estimated to cost us $6-10 billion every year⁴) -- some of these insurance companies are overcharging the government through various fraudulent means. For example, they have been submitting codes for patients’ conditions that are more severe than they were actually diagnosed in order to receive a higher reimbursement⁵. The current rules allow Medicare Advantage insurers to be compensated at a higher rate than traditional Medicare while not enforcing they meet the equivalent standard of care. The result: more money for crooked insurance companies while bleeding the Medicare trust fund dry.

CMS can fight back -- with our help

The Center for Medicare & Medicaid Services is meant to regulate the program, but it has fallen short on responding to the insurance companies’ shameless money-grabbing. The agency has largely not enforced its existing rules, and changes have been slow and inadequate.

That’s why driving formal comments about this proposed change is so critical. If there is a public outcry for CMS to take more action, the agency will have to get aggressive on these companies: through regular audits, collection of overpayments, implementation of common-sense guardrails to prevent unnecessary denials, and punishment and removal of insurance companies that break the rules, including ending their contracts. This reform would do more than save money -- eliminating the very worst of the MA plans would save lives by ensuring patients get the care they need when they need it.

The process to leave a public comment might seem intimidating, but we are ready to walk you through it! Here's how:

1. First, go to the Federal Register's website, and click on the green box labeled "Submit a formal comment" on the right side of the page. 
2. Next, draft your comment in the text box. Keep in mind that the most impactful comment will be personal, so be sure to note if you or your loved ones are on or will soon be on Medicare. You can also share details specific to your state or community. Speaking from personal experience and concerns makes for an effective comment. (And if you need talking points and additional guidance on how to draft your comment, check out this resource from Indivisible OneNYS!)
3. For the question "What is your comment about?", choose "Private Industry - Health care" from the drop-down menu.
4. Enter your email address.
5. For the question "Tell us about yourself! I am...", select "An Individual" with the megaphone icon.
6. Finally, scroll down to fill in your contact information and submit your comment.

It's time for CMS to be bold and hold the insurance companies accountable by cracking down on fraud and overpayments, ridding the program of bad actors, and providing quality healthcare as promised. Submit your comment today by the January 5, 2024 deadline, and invite your family, friends, and neighbors to join in.

In solidarity,
Indivisible Team

[1] Total Number of Medicare Beneficiaries by Type of Coverage, 2021. KFF. 

[2] “Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds.” The New York Times, April 28, 2022.

[3] “Tiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow.” KFF Health News, October 23, 2023.

[4] Medicare Advantage and Deceptive Marketing. The Center for Economic and Policy Research, November 7, 2023. 

[5] “‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions.” The New York Times, October 8, 2022.