Medicare Advantage Has Many Issues: HHS, CMS Need To Make New Policies To Reform Medicare Advantage – Send Letter To Your Representatives

Retirees have serious concerns about the Medicare Advantage program.

Editor’s Note: As we have covered previously, here and here, Marianne Pizzitola has been fighting alongside retired municipal union workers to have their previously available choice of Medicare options restored to them.  It has thus far been a lengthy legal battle. 

The New York City Council and the New York State Assembly could easily restore this fundamental contractually guaranteed option for these workers by passing the bills that are before both bodies at the current moment. 

Retirees worked their entire lives, and now in their later years, their benefits are being taken from them in order to pay for raises for current municipal workers.  While these retired union members still stand in solidarity with the active workers, and want them to get pay raises and better working conditions, it should not be on the backs of the retired workers. 

Also to consider is the fact that one day, these workers, too, will be retired.  At that time, they will be subject to this new form of healthcare, which is inappropriately termed Medicare “Advantage,” and they will become subject to gatekeeping by the insurance companies. 

This type of plan is not run by the federal government, and it is not subject to the same rules that regular Medicare plans are.  This means that they can change the terms of the agreement at any time.  They can decide to charge premiums for members, thus diminishing their healthcare while increasing their costs. 

Most importantly, however, is the intrusion of the insurance adjuster or company as adjudicator of care.  Medical decisions no longer belong to the individual and their doctor; there is now a third party who must approve every procedure, deciding if it is necessary, and if it is not, forcing the patient to pay out-of-pocket after the fact. See an example here where an insurance company used computer algorithms to randomly deny rehabilitation care for seriously ill patients, even though they knew the algorithm had a high error rate.  

A similar lawsuit against Cigna by the US Government was settled as follows: “The $37 million settlement resolves claims that CIGNA submitted to the Government false and invalid patient diagnosis codes to artificially inflate the payments CIGNA received for providing insurance coverage to its Medicare Advantage plan members.” As mentioned in Marianne’s second interview, the issue with these inflated payments is that they drain the Medicare Trust, which is where the payments come from for Medicare.  This means that the trust will run out of money faster, and Medicare will at some point become untenable.  

Many insurance companies take months if not longer to approve claims, and if they choose not to approve a given claim, the patient is then responsible.  Unfortunately, we are not talking about small amounts: in many cases, any one treatment or drug can cost thousands of dollars, which most people who are retired simply cannot afford. 

This can destroy their lives from a financial stability and credit-rating standpoint as well, at its most extreme end.  Medical bills can and have destroyed people’s financial lives, causing them in many cases to have to sell their homes or have a lien placed on them to pay for their medical bills. See this report by NPR that discusses this: “Some lost their homes. Some emptied their retirement accounts. Some struggled to feed and clothe their families. Medical debt now touches more than 100 million people in America, as the U.S. health care system pushes patients into debt on a mass scale. People from all walks of life and all corners of the country are living with health care debt.

The main issue of the current fight against Medicare Advantage is the agreement the City of New York made with these workers when it hired them and signed their union-negotiated contract.  Watch Marianne’s second interview to learn more about the issues facing retired municipal workers.

From Marianne Pizzitola of the NYC Organization of Public Service Retirees

Currently,  a letter is being circulated in the House and Senate, led by Representatives Pramila Jayapal, Rosa DeLauro, Jan Schakowsky, and Senator Elizabeth Warren, asking HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure to implement policies addressing major issues with Medicare Advantage.

We are deeply aware of the problems with Medicare Advantage, and we have an opportunity to impact decision-making that is happening at the federal level, which will have a huge impact on our fight to stay on traditional, publicly administered Medicare.

Today, in a joint effort with Be A Hero, Ady Barkan’s grassroots organization to #ReclaimMedicare, The NYC Organization of Public Service Retirees is asking everyone around the country to call and email their Congress person and Senators using our email and call tools, and ask them to sign the letter to protect Medicare!

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Reforms in Medicare Advantage are needed to protect those in them, and we should not be forcing retirees into Medicare Advantage against their will.   Auto-enrollment into privatized Medicare, leaving the retiree with little or no ability to stay in Traditional Medicare, is un-American, said Marianne Pizzitola, President of the NYC Organization of Public Service Retirees.

“The time is now. No one should die from delays or denials of care or reduced access to providers because insurance companies are putting profits over people.”

Banner Image: Gatekeeping health insurance and chaining people to medical debt. Image Credit – Joshua Hoehne