by Kay Tillow

Originally published on DailyKos.com

In a television ad repeated incessantly, 60’s quarterback star Joe Namath reads his lines to promote the Medicare Coverage Helpline. “Are you getting all the benefits you deserve?” He ticks off the new benefits. You may be able to lower your out of pocket costs and get extra benefit now, he says.

The ad announces that the Center for Medicare and Medicaid Services has officially authorized new benefits that Medicare Advantage Plans may include. “One simple call gives you free, professional assistance to help you get more benefits and save money,” says Namath. It sounds like a public service announcement from Medicare.

But it isn’t. It’s a pitch to sign up in the privatized, for-profit Medicare Advantage plans—and it’s a scam. It is true that a person may be able to lower monthly costs by enrolling in one of these plans. That’s a powerful incentive in a time when the majority of seniors live on tight budgets, many just an inch from disaster. The laws and regulations allow these insurance companies to lure seniors away from traditional Medicare, and Congresspersons of both parties should be held responsible.

Namath continues: “And like you I’m at home staying safe, but I wanted to get this message out. To make these uncertain times easier and safer while at home, Medicare Advantage plans have added new benefits including telephone appointments with your doctors, in home aides, home delivered meals, home delivered prescriptions, and so much more.”

He makes it seem to be a new opportunity provided by Medicare because of the corona virus that is keeping us homebound.

“But you don’t get all the benefits automatically, you need to enroll. The easiest way to enroll is to call the Medicare Coverage Helpline. It’s now more important than ever to make sure that your Medicare coverage is up to date,” says Namath.

It mimics a public service announcement—there are new benefits to help out in the pandemic but the benefits aren’t automatic, you have to enroll. That doesn’t sound like you are abandoning your traditional Medicare plan and allowing Medicare to give an annual sum to the for-profit insurance company that has now taken you into its scheme. But once you sign up, you’ve been had.

You may be okay for a time and save money monthly – as long as you don’t get sick. Once you need to use the plan, you will discover the problems that come from being in a for-profit plan that makes more when it denies you care. Your choice of physicians will be restricted to a list. The specialist you need may not be anywhere near where you live. The hospitals and rehabs centers will be limited. The post-hospitalization facility available to you is likely to be the one with the worst reputation. The drugs you need may now cost a fortune.

Tom Mills of San Diego was in one of these Medicare Advantage plans. Following a mitral valve repair and a mild stroke, his plan began to charge him hundreds of dollars in monthly copays for drugs and other services. He had to pay $295 a night for a hospital stay.

Then he learned the even worse news. If he tries to escape these exorbitant costs by returning to traditional Medicare and a prescription plan, he will need a supplemental Medigap plan to handle the 20% copays and deductibles. But he now has a pre-existing condition. A broker for health insurance told Mills that no supplemental plan would cover him and that applying would be a waste of time.

Namath didn’t mention that in the ad.

When seniors first sign up for a Medicare plan, they are protected by law against discrimination for pre-existing conditions in the purchase of a Medigap plan. But when a person tries to change back to traditional Medicare later, that protection is gone. Only four states have regulations to prohibit such practices.

Mr. Mills no longer saves that monthly sum on his Medicare Advantage plan; he pays extra.

The Medicare Advantage Plans are smiling all the way to the bank. In 2019 each Medicare Advantage beneficiary cost taxpayers $11,822 while those in original Medicare cost $10,813 each—that’s over $1,000 more and over 9% more per person for the for-profit insurers!

The Center for Medicare and Medicaid Services estimates that the Medicare Advantage insurers will be overpaid by $200 billion over the next decade.

Despite the problems of purchasing a Medigap plan, the negative experiences that Medicare Advantage patients encounter once they get sick induce many to return to traditional Medicare. It all works so well for the insurance companies! While the patient is healthy with few expenses, the company rakes in the money. Once the patient becomes ill and needs more care, many patients, facing massive expenses, will return to original Medicare. Now the extra expenses of a sicker patient will fall on the public once again.

That’s the way this for-profit system functions. The poor, the disabled, the sick and the elderly are covered under the public programs, Medicaid and Medicare, leaving the healthy, vibrant families to the private insurers who profit from the lower costs of care for the healthy.

Not only do these Medicare Advantage Insurance companies profit at the public trough, they use the seniors who are signed up in their plans to lobby Congress to continue with these rip-offs. America’s Health Insurance Plans (AHIP), the organization of health insurance companies, keeps the deceptions going by telling seniors to let their Congressperson know that their Medicare plan is in jeopardy. All legislative efforts to reduce the massive ill-gotten gains of these companies are defeated by AHIP’s shrewd use of the popular “protect Medicare” sentiment to ward off any reform of the Medicare Advantage plans.

In 2019 368 members of Congress, a solid majority, signed the letter in favor of Medicare Advantage plans. AHIP thanked Congress for the overwhelming support.

The Senate letter includes 66 signatures and the House letter over 300, including many who ought to know better.

The insurance industry manipulates our democracy.

That’s just the beginning of the shameful marketing of Medicare Advantage plans. The Joe Namath ad for the Medicare Coverage Helpline includes some tiny print that no one could possibly read on the television. The fine print of the ad says “The Medicare Coverage Helpline is a private for-profit lead generation campaign and does not offer insurance and is not an insurance agency or broker. Your call is sold to a licensed insurance agent….”

The ad also states that Medicare Coverage Helpline…(and others) are all service marks or trademarks owned by TogetherHealth PAP, LLC.” In June of 2019, TogetherHealth was acquired by Health Insurance Innovations, a company that is facing at least two class-action lawsuits over its alleged role in a health insurance scam that bilked millions of dollars from consumers and that the FTC shut down last fall, reported Truth in Advertising.

Now the Medicare Payment Advisory Commission (MedPAC) announces that Medicare is spending more than planned during the pandemic and that funds will run short by 2024. There is a solution to all of this. A well-designed national single payer plan, an Improved Medicare for All, would boot the Medicare Advantage cheats, solve Medicare’s funding future, and cover everyone, not just the elderly, for all medically necessary care.

Such a plan has been set forth by Physicians for a National Health Program.

The plan removes the profits from the system, allowing our wealth to instead expand care to all, ending forever the for-profit scams and the denial of care because of inability to pay.

2020-09-14