Medicare’s open-enrollment period is here, meaning millions of older Americans and people living with disabilities can compare plans and make changes to their healthcare coverage. If recent trends hold true, more than half of all enrollees will choose a Medicare Advantage (MA) plan — the private alternative to traditional Medicare.
What many enrollees don’t understand is that their “choice” has effectively been made for them.
The U.S. government now pays MA plans at least 22% more per enrollee than it would cost to cover the same person under traditional Medicare. But more money doesn’t mean enrollees get better care. MA plans perform no better and in some aspects are worse than traditional Medicare. Nor does the money appear to provide enrollees with meaningful control over their coverage decisions. Instead, MA plans bombard enrollees with a complicated array of options so overwhelming that almost 70% of people don’t even try to compare what’s available to them.
Most alarmingly, in spite of massive federal subsidies, MA plans are erecting more and more barriers to patient care, including arduous prior authorization requirements that can delay necessary procedures, and narrow networks that may exclude higher-quality providers — all while often failing to save enrollees money on care.
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Nevertheless, the MA program continues to grow because for many enrollees, traditional Medicare — with its 20% coinsurance and lack of an out-of-pocket spending limit — isn’t financially viable. For an older American living on a low or fixed income, making the choice between a zero-dollar-premium MA plan that claims to cover all the necessities, or paying upwards of $200 a month for a supplemental Medigap policy to guard against financial catastrophe — plus additional premiums for a supplemental prescription-drug plan and any dental, vision and hearing services — isn’t really a choice at all.
In recent years, the Biden administration has tried to address some of MA’s limitations by bringing more consumer protections, transparency and accountability to the program. While these efforts need to continue, we also need congressional action to improve the Medicare program for everyone so the choice between MA and traditional Medicare becomes a meaningful one.
If Congress instead doubles down on the further privatization of Medicare, the results could be disastrous. For example, the far-right authoritarian playbook known as Project 2025 calls for making MA the “default” for all enrollees. This would effectively push even more people into the program. If, as a result, just 50% more people enrolled in MA, the Center for American Progress estimates it would contribute toward $2 trillion in waste over the next decade while providing no meaningful health benefit to enrollees.
On the other hand, Congress could level the playing field by giving Medicare enrollees a real choice between MA and traditional Medicare. To put the full scale of the government’s investment in MA into perspective: The Center for American Progress estimates the program will be overpaid by as much as $127 billion in 2024 alone, with any “savings” many MA plans achieve accruing to shareholders.
That’s more than enough money to expand traditional Medicare coverage to include dental, vision, and hearing benefits and introduce an annual cap on out-of-pocket expenses — reforms that would help all Medicare beneficiaries. The money could also be used to fund home-based caregivers, a critical Medicare coverage gap.
As Medicare beneficiaries navigate potential changes to their coverage during this open-enrollment period, the reality is that far too many enrollees won’t have a meaningful choice set before them — but lawmakers do.
Andrea Ducas is the vice president of health policy at the Center for American Progress. David Lipschutz, J.D., is the co-director of law and policy at the Center for Medicare Advocacy.
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Source: finance.yahoo.com