Medicare Private Health Plan Monitoring Project

This past April, the Medicare Rights Center launched the Medicare Private Health Plan Monitoring Project to learn about the experiences of people with Medicare enrolled in these plans. In the past two months, we have received story after story from people with Medicare, their family members and friends, counselors and caseworkers about the problems they have encountered dealing with these plans.

The insurance industry is reaping billions of dollars in over-payments from Medicare. Hoping to keep that gravy train rolling, the industry touts the extra benefits and better coverage in private plans. But it won’t brag about the higher cost sharing some plans charge for chemotherapy and other medicines compared to Part B under Original Medicare. It won’t boast about the Florida couple whose plan told them it would cover surgery in their local hospital but then denied payment claiming the hospital is not in the plan’s network and so they must pay for the surgery themselves.

The insurance industry insists that private plans are especially beneficial for low-income people with Medicare. But it keeps quiet about the people with Medicare and Medicaid who enroll in these plans with the promise of extra benefits and end up being charged co-payments they did not have to pay under Original Medicare.

The insurance industry argues that private plans offer consumer choice and empowerment. But it leaves out the abusive marketing tactics sales agents use to get people to enroll. There are stories about agents claiming to represent Medicare, aggressively pushing plans on people with Medicare in their homes and workplaces, forging signatures, leaving out crucial information about costs and restrictions, lying about how the plans work or even threatening people with loss of all their Medicare or Medicaid benefits if they do not join the plan.

These stories are disturbing, serious evidence of a program that prioritizes profits far above the health and well-being of its enrollees. We have also heard from insurance sales agents and others who have worked for insurance companies, whose testimonials confirm what people with Medicare have experienced. One sales agent wrote to us about being troubled by the pressure to sell Medicare Advantage plans, regardless of whether or not they were right for a particular customer. He told us about the company’s emphasis on earning profits and the lack of knowledge his superiors had about the plans.

Our representatives in Congress must choose who they will listen to when it comes to private Medicare health plans: slick insurance lobbyists armed with their talking points and scare tactics or the voices of ordinary people across the country whose stories call for cutting the over-payments and holding plans accountable for their actions. It’s time for them to decide.

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