SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
");background-position:center;background-size:19px 19px;background-repeat:no-repeat;background-color:var(--button-bg-color);padding:0;width:var(--form-elem-height);height:var(--form-elem-height);font-size:0;}:is(.js-newsletter-wrapper, .newsletter_bar.newsletter-wrapper) .widget__body:has(.response:not(:empty)) :is(.widget__headline, .widget__subheadline, #mc_embed_signup .mc-field-group, #mc_embed_signup input[type="submit"]){display:none;}:is(.grey_newsblock .newsletter-wrapper, .newsletter-wrapper) #mce-responses:has(.response:not(:empty)){grid-row:1 / -1;grid-column:1 / -1;}.newsletter-wrapper .widget__body > .snark-line:has(.response:not(:empty)){grid-column:1 / -1;}:is(.grey_newsblock .newsletter-wrapper, .newsletter-wrapper) :is(.newsletter-campaign:has(.response:not(:empty)), .newsletter-and-social:has(.response:not(:empty))){width:100%;}.newsletter-wrapper .newsletter_bar_col{display:flex;flex-wrap:wrap;justify-content:center;align-items:center;gap:8px 20px;margin:0 auto;}.newsletter-wrapper .newsletter_bar_col .text-element{display:flex;color:var(--shares-color);margin:0 !important;font-weight:400 !important;font-size:16px !important;}.newsletter-wrapper .newsletter_bar_col .whitebar_social{display:flex;gap:12px;width:auto;}.newsletter-wrapper .newsletter_bar_col a{margin:0;background-color:#0000;padding:0;width:32px;height:32px;}.newsletter-wrapper .social_icon:after{display:none;}.newsletter-wrapper .widget article:before, .newsletter-wrapper .widget article:after{display:none;}#sFollow_Block_0_0_1_0_0_0_1{margin:0;}.donation_banner{position:relative;background:#000;}.donation_banner .posts-custom *, .donation_banner .posts-custom :after, .donation_banner .posts-custom :before{margin:0;}.donation_banner .posts-custom .widget{position:absolute;inset:0;}.donation_banner__wrapper{position:relative;z-index:2;pointer-events:none;}.donation_banner .donate_btn{position:relative;z-index:2;}#sSHARED_-_Support_Block_0_0_7_0_0_3_1_0{color:#fff;}#sSHARED_-_Support_Block_0_0_7_0_0_3_1_1{font-weight:normal;}.grey_newsblock .newsletter-wrapper, .newsletter-wrapper, .newsletter-wrapper.sidebar{background:linear-gradient(91deg, #005dc7 28%, #1d63b2 65%, #0353ae 85%);}
To donate by check, phone, or other method, see our More Ways to Give page.
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, it has become a wildly profitable scheme for private insurance giants.
The quasi-privatized system called “Medicare Advantage,” otherwise known as Part C, was created in 2003 as a means of expanding the role of private sector corporations in the publicly-funded Medicare system. Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, MA has become a wildly profitable scheme for private insurance giants, who have become adept at taking advantage of Medicare’s billing model to claim exorbitant profits. At this point, MA is more profitable for many companies than their conventional insurance businesses.
And the program continues to grow. Medicare Advantage now has more enrollees than traditional Medicare, thanks in no small part to aggressive public relations campaigns that sell seniors on the idea that the plans cut costs and increase choice. Congress has simultaneously failed to plug the holes in traditional Medicare, pushing seniors towards MA to avoid high out-of-pocket costs. Policymakers can fill these gaps and guarantee true comprehensive coverage simply by redirecting the overpayments to MA insurers into Medicare.
Numerous studies and media investigations have documented the problems with Medicare Advantage. What follows is a collection of some of the most notable figures documenting the high costs of this failed experiment in privatizing Medicare.
$88-$140 billion
The amount that the federal government overpaid private insurers under Medicare Advantage in 2022, according to the Physicians for a National Health Program (PNHP).
$612 billion
The amount that Medicare Advantage plans overcharged the federal government due to upcoding and favorable selection between 2007 and 2023, according to the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency established to advise Congress on issues affecting the Medicare program.
$600 billion
According to one study, this is the projected excess spending between 2023 to 2031 due to the ways that Medicare Advantage plans use ‘upcoding,’ the process of classifying beneficiaries as being sicker than they really are in order to increase payments.
$35 billion
The amount that MedPAC estimates taxpayers will overpay MA insurers this year through ‘favorable selection,’ the practice of targeting healthy seniors for their plans.
$4.2 billion
The amount that MA insurers received for questionable home visit health risk assessments (and related chart reviews) in 2023, according to an October 2024 report from the Department of Health and Human Services.
80 percent
The percentage of mental health providers in a sample of MA plans that were determined to be “ghosts” (meaning they were unreachable, not accepting new patients, or not in-network), according to a recent Senate investigation.
1.8 million
Estimated number of Medicare Advantage customers whose health plans will be canceled in 2025.
167 percent
The amount that drug deductibles will increase for roughly two-thirds of all Medicare Advantage enrollees next year.
55.7 percent
The increase in MA care denials from 2022 to 2023, according to research from the American Hospital Association.
54 percent
The increase in the denial rate for long-term acute care hospitals in Humana’s Medicare Advantage plans from 2020 to 2022 (Senate Majority Staff Report, 10/17/24).
$660 million
The amount of taxpayer money that CVS/Aetna stashed away in 2018 by denying Medicare Advantage patients’ claims for treatment at inpatient facilities (Senate Majority Staff Report).
78 percent
The percentage of physicians in a 2023 American Medical Association survey who said that Medicare Advantage’s prior authorization processes caused a recommended treatment for a patient to be abandoned.
$6 billion
One estimate of the amount spent in 2022 on the marketing companies that work to attract new subscribers in Medicare Advantage plans.
556,068
The number of English-language TV commercials touting Medicare Advantage that aired during the seven-week open enrollment period in 2022.
$50 billion
The amount that the Wall Street Journal estimates private insurers received between 2018 and 2021 for “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments.”
$2,329
The amount that MA insurers receive per beneficiary above the estimated costs of Medicare.
$1,730
The gross profit margin posted by MA companies in 2021 – more than double their profit margin on the individual market.
$172 million
The amount that Cigna agreed to pay in 2023 to “resolve allegations that it knowingly submitted and failed to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase its payments from Medicare.” The Justice Department continues to investigate similar allegations involving other MA providers.
The organizing I’ve been a part of has shown not only are seniors engaged, but they are ready to take on fights progressives care about, like protecting public healthcare and fighting back against privatization.
U.S. Vice President Kamala Harris lost the election, but when all the votes are tallied, she may have won the senior vote. If so, she would be the first Democrat to do so since Al Gore did in 2000.
As of September 29, CNN reported that the average poll had Kamala Harris up with seniors by three points. Harris’ strong ratings continued to hold in a poll of likely voters by ABC/Ipsos, released a week later, showed Harris up 51-46%. CNN Exit polling has the two candidates tied with voters over 65, a group Trump won by 7%, and 5%, in 2016 and 2020 respectively.
Senior citizens took a beating over the last year, as the primary conversation about older people was centered on the two older men running for president, especially President Joe Biden. I get it, and was glad Biden stepped aside, but by the time he did there’d been plenty of collateral damage. Mainstream news media and popular culture took potshot after potshot at Biden, and sometimes Trump, with jokes about dementia. One Stephen Colbert bit featured Trump being inaugurated with a stack of Depends instead of a book of scripture.
One group that I think few would think we should more aggressively court, fold in, and organize with are seniors, but that is a self-defeating path if we want to realize significant change down the road.
I learned of Biden stepping down while among a hundred people, almost all seniors, filing into a meeting of a County Board of Supervisors in rural Wisconsin. They were there to protest a plan to privatize their beloved county-owned nursing home that in one form or another had been part of the county for more than a century. So many people showed up that the county had to create an overflow room to accommodate everyone. Then, one by one, older Democrats, Independents, and Republicans took to the podium and expressed their ire at the idea of selling off a venerable community institution that they had all paid into for years or a lifetime. It was a fight for publicly funded and run healthcare, and against privatization, and had cross-partisan appeal.
They were not alone in this fight, as small-town seniors in a handful of counties were doing the same, flooding into county board meetings, marching (or driving their tractors) in local parades, and giving pro-privatization county board members hell every step of the way.
In these meetings and marches, I experienced people, 75, 80, and older, having a third, even fourth, act, building relationships across partisanship, doing things for the first time, and some fighting for what was right with their very last breath. None of these fights to protect public healthcare would be possible if not for the leadership of people over 65. They have time, wisdom, and experience to contribute, and we need every bit of it.
In community organizing circles, there is a dearth of organizing of older working class people. The push has been to get younger. I get it, and over the years have trained hundreds of young organizers to organize younger people. But I would encourage us to think about the role of older people in building movements and a “larger we" that can get us to the other side of this tumultuous period in American history.
For those of us who crave significant change, whether as sweeping as doing away with the Electoral College, or an expansion of Medicare, or a reinstatement of some basic voting rights, It will require more than razor thin majorities coming to an agreement. It will require super majorities of people being in agreement on many things and across many states. If we want big change, we need a lot more people.
In many states older people are the fastest growing age demographic, becoming a higher percentage of the electorate, and will have a lot to say about who wins elections. Between 2010 and 2022, the 65-and-over population grew by 48%.
As swing states have been a hot topic of conversation, here’s how the aging of America is playing out in a few of those. The number of Wisconsinites aged 75 and older is projected to grow by 75% over the next two decades. Michiganders over 85 are the state’s fastest growing age group, and Pennsylvania’s over 65 population is already at more than 2.2 million. That’s a lot of people.
Seniors consistently turn out at the highest rate of any age group. According to the U.S. Census, voter registration numbers for those over 65 to 74 hover at 78%, higher than any other age group.
The organizing I’ve been a part of in Wisconsin has shown not only are seniors engaged, but they are ready to take on fights progressives care about, like protecting public healthcare and fighting back against privatization.
Seniors have united across partisanship to save their public nursing homes. In the spring elections, they took that energy to the ballot box and a number of county board members who led the charge to privatize, including the chairs of two counties, were voted out and replaced by candidates who supported keeping their nursing homes publicly owned. People in the community expanded who was in the fight, and they won.
There’s been a tendency among some progressives to look to narrow who is in, to slice us into smaller groups, and to not work in coalition with people unless we agree on all the things. One group that I think few would think we should more aggressively court, fold in, and organize with are seniors, but that is a self-defeating path if we want to realize significant change down the road.
If we want big things, we need more people. Let’s look to expand, not narrow, who is in, and, considering the fact that older people are becoming a larger percentage of the population, it would seem a major mistake to not place more focus here.
"Many of these plans are a maze of prior authorization word salad designed to deny seniors the coverage they're already paying for," said Sen. Ron Wyden.
A trio of leading congressional Democrats expressed alarm Wednesday about increasingly widespread abuses and care denials by for-profit Medicare Advantage insurers as allies of GOP presidential nominee Donald Trump aim to massively expand the for-profit program.
"We are writing to express our concerns on ongoing problems with Medicare Advantage (MA) that seem to be getting worse," Sen. Ron Wyden (D-Ore.), Rep. Frank Pallone Jr. (D-N.J.), and Rep. Richard Neal (D-Mass.) wrote in a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS).
"We are concerned that in many instances MA plans are failing to deliver, compromising timely access to care, and undermining the ability of seniors and Americans with disabilities to purchase the coverage that’s right for them," the Democratic lawmakers continued. "We continue to hear alarming reports from seniors and their families, beneficiary advocates, and healthcare providers that MA plans are falling short, and finding a good plan is too difficult."
Wyden, Pallone, and Neal pointed specifically to MA plans' growing use of prior authorization, a complex, barrier-ridden process whereby doctors must demonstrate a proposed treatment is medically necessary before the insurer will cover it.
The process is notorious for harming patients—sometimes fatally—but 99% of MA enrollees are required to obtain prior authorization for at least some medical services, according to the health policy research group KFF.
"Overuse of prior authorization is not only harmful to patients, it hinders healthcare providers' ability to offer best-in-class service," the congressional Democrats wrote, pointing to MA plans' increasing use of artificial intelligence-backed algorithms to decide whether to accept or deny patients' coverage claims.
The lawmakers also voiced concerns about MA plans' deceptive marketing practices—which are particularly dangerous to people with disabilities, as they could potentially be duped into enrolling in an MA plan that doesn't meet their health needs.
"We call on CMS to use every regulatory, oversight, and enforcement tool at the agency's disposal to rein in rampant misuse of prior authorization, simplify the experience of choosing a Medicare plan, and put an end to rampant marketing abuses," the lawmakers wrote.
The Democrats' call for a crackdown on MA abuses stands in stark contrast to a plan put forth by Project 2025, which has proposed making Medicare Advantage the default enrollment option for the nation's seniors—a change that one critic said would mean "destroying Medicare as we know it" while providing a huge boon to private insurance companies.
Though Trump has attempted to distance himself from Project 2025, some 140 people who served in his first administration helped craft the far-right agenda, and one architect of the proposals said earlier this year that the Republican nominee is "very supportive of what we do."
The Guardian's Jessica Glenza reported this past weekend that "one of Republicans' only healthcare policy specifics involves further privatizing" Medicare by boosting Medicare Advantage, privately run plans that have proven significantly more costly than traditional Medicare without obvious improvements in quality of care—leading some experts to call for the program's abolition.
Glenza noted that Project 2025's healthcare proposals were authored by Roger Severino, who previously served as Trump's director of the Office of Civil Rights at the U.S. Department of Health and Human Services.
Just over half of the Medicare-eligible population in the U.S. is currently enrolled in a Medicare Advantage plan, according to KFF.
The Medicare Payment Advisory Commission, a nonpartisan congressional agency, has estimated that the federal government will spend $83 billion more funding MA plans in 2024 than it would have paid to cover the same patients under traditional Medicare.
A recent analysis by the Center for American Progress (CAP) projected that "if making MA the default option for enrollees were to expand the proportion of Medicare beneficiaries in MA to 75%... wasteful spending could approach an eye-popping $2 trillion over 10 years."
"Project 2025 would put more control in the hands of profit-driven corporations by making MA the default enrollment option for Medicare beneficiaries," CAP concluded. "Corporations, not doctors or patients, would be able to control what care an even greater number of enrollees can and cannot receive, while enriching their bottom lines and threatening Medicare's future."