Medicare Disadvantage

Commercial health insurers and their investors have been profiting off the Medicare program long before Direct Contracting and REACH. The so-called “Medicare Advantage” program allows these famously wasteful companies to administer health benefits for seniors and people with disabilities. It is likely that over half of Medicare beneficiaries will be under a Medicare Advantage plan in 2023.

By nearly any measure, Traditional Medicare is a better deal for patients, doctors, and taxpayers. Beneficiaries may pay lower premiums up-front, but they can be burdened later on with high cost-sharing, narrow provider networks, and outright denials of care—burdens that they would not have to bear if they had enrolled in Traditional Medicare.

Dr. Ed Weisbart explains the problems with Medicare Advantage

Physicians call for an end to Medicare Advantage

During the summer of 2022, the Biden administration issued a call for public comment on “ways to strengthen Medicare Advantage.” Physicians for a National Health Program, which represents more than 25,000 doctors nationwide, submitted a comment arguing that the program cannot possibly serve the needs of patients and commercial health insurers…and that something would have to give.

“It would be far more cost-effective for CMS [the Centers for Medicare and Medicaid Services] to improve Traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system,” reads the statement, “than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare.”

Ready to take action? Write a letter to the editor or op-ed warning about the dangers of Medicare Advantage. You may also wish to call your member of Congress at (202) 224-3121 and urge them to both crack down on Medicare Advantage profiteering and make necessary improvements to the Traditional Medicare program. Questions? Email organizer@pnhp.org.