What’s the Problem with Medicare Advantage?

And why we need Improved Medicare for All

The recent news that Martin’s Point, a health care nonprofit based in southern Maine, will pay more than $22 million in a settlement with the U.S. Justice Department for fraudulent billing practices in its Medicare Advantage plans brings home the problems with the program, which uses federal funds to pay private companies to manage health insurance for Medicare beneficiaries.

Medicare Advantage plans are increasingly popular, now covering just over 50% of all Medicare enrollees, for understandable reasons—they often have lower premiums and added benefits such as for vision and hearing care.

But the reality of Medicare Advantage is much more complex.

Both for-profit and nonprofit corporations that offer MA plans have found ways to boost their revenues by limiting patients’ choices in narrow networks, denying or delaying medically necessary care, subtly marketing to healthier seniors, and inflating the medical conditions of patients to increase billing reimbursements through “upcoding,” to the tune of tens of billions of dollars.

Researchers estimate that overpayments to Medicare Advantage now top 20%, or $75 billion per year.

Private insurers are steadily eroding the foundations of Traditional Medicare, undermining a popular and successful program that many Americans have relied on since 1965. If we want to build on and improve Medicare, and expand it to include all Americans, we need to protect it from private interests.

Learn more on our website.

Sign the Be a Hero petition to #ReclaimMedicare

Volunteers Needed!

Common Ground Country Fair

September 22-24

We’re excited to be back at the Common Ground Fair this year! We’ll have a table in the Social and Political Action tent, and we’ll give a talk on Friday morning.

Volunteers are needed to staff our table and talk with fairgoers about health care for all.

Sign up to volunteer here.
Questions? Contact Liz, esolet@maineallcare.org.

Photo: Elijah Hail, Unsplash

Maine AllCare News

Penobscot referendum moves forward

MAC volunteers around the state have successfully pursued resolutions in their communities in support of universal health care, usually through a selectboard or council vote. We’re also testing out a ballot initiative process in Penobscot, putting the question directly to voters.

Here’s the question that will be on the ballot in Penobscot in November:

Shall the citizens of Penobscot call on the Maine Legislature to create a publicly funded healthcare plan that provides every Maine resident with comprehensive medical care?

___ Yes ___ No

Find more information on our website and the full text of the referendum.

We’ll include more details in upcoming newsletters. You can also follow us on Facebook to stay current with news and events.

Maine News

New law requires clear labeling of marketing materials from private insurers

One of the brighter spots in legislative activity this past year was the passage of LD 1271, “An Act to Require a Disclaimer on Promotional Materials for Medicare, Medicaid and MaineCare Products by Private Entities,” sponsored by Senator Ben Chipman. The bill requires promotional materials from private insurers, which often look similar to documents from public insurance programs, to be clearly labeled. It became law without Gov. Mills’ signature in June.

Q&A: What’s in the 2023 Medicare for All Act?

The Medicare for All Act was reintroduced in both the House and Senate in May 2023. What would this legislation do?

Q: What would be covered under the 2023 Medicare for All Act?

A: Comprehensive health care including all primary care, hospital and outpatient services, dental, vision, audiology, women’s reproductive health services, long-term services and supports, prescription drugs, mental health and substance abuse treatment, laboratory and diagnostic services, ambulatory services, telehealth, and more.

Q: How would we pay for the improvement and expansion of Medicare?

A: Medicare for All would simplify our health care system and save billions of dollars that now go to profits for private insurers, administrative costs, and inefficiencies due to the complexities of the current multi-payer system. Medicare would negotiate drug prices, and global budgets would be provided to all care centers to help contain costs.

Q: Would l be able to choose my doctors and other health care providers?

A: Yes. Patients would be free to choose the doctors, hospitals, and other providers they wish to see, for covered services, without worrying about networks, tiers, or similar restrictions.

Q: How would the Medicare for All Act affect what I pay in premiums, deductibles, and co-pays?

A: Enrollment in Medicare for All would not require any private insurance premiums or deductibles. Patients would not be charged any co-pays or other out-of-pocket costs for receiving care.

Q: How would we get from here to there?

A: The transition to Medicare for All would occur in two years, with people over the age of 55 and under the age of 19 eligible in the first year, and all people living in the U.S. eligible beginning in the second year.

Source: 2023 Medicare for All Act summary

More information here

Your voice

The problem with upcoding in Medicare Advantage

Julie Pease (Topsham) at centralmaine.com

“Here’s how ‘upcoding’ happens: I am 66 years old, in good health. I am enrolled in a Medicare Advantage plan. I am getting several calls each month from the insurance company, urging me to take advantage of a ‘free’ health screening. The purpose of this home health visit is not to provide health care. Rather, its purpose is to ‘upcode’: to add irrelevant diagnoses to my medical history just to increase the insurance company’s payout.”

Martin’s Point case shows need for Medicare for All

Karen Foster (Portland) in the Portland Press Herald

“Over and over again, we bemoan the failings of treating health care as a business. Yet we are the only developed country in the world that keeps trying to do so.”

Would you like to write a letter to the editor in support of universal health care?
Check out this guidance on how to write an effective letter—and why they are so important. Please reach out with any questions!

Upcoming Events

Demystifying Medicare: Things to know before open enrollment starts
September 20
8-9 pm ET

Zoom webinar with Dr. Ed Weisbart, chair of the Consumers Council of Missouri and the Missouri chapter of Physicians for a National Health Program (PNHP). More info and registration link

Maine AllCare statewide virtual meeting
October 15
4-5:30 pm

Save the date! More details to come.

Support Our Work

Turn your bottles and cans into universal health care!

Clynk is a simple way to support Maine AllCare’s work—just fill up a Clynk bag with your returnable bottles and cans, put on a MAC sticker, and drop them off at a nearby Hannaford store.

Clynk bags are available at participating Hannaford stores for a small fee. To get MAC stickers, contact us and we’ll put them in the mail to you.

Thank you to all who are using Clynk to support our work!

So far you have dropped off more than 36,800 containers to Clynk. That’s enough to save the emissions equivalent of driving 11,669 miles. Or fill 375 lobster traps.

Have you gotten your Maine AllCare bumper sticker?

Contact us to request yours!

Are you already sporting a sticker?

Send us a photo! We love to see the message spreading far and wide.

If you have trouble accessing content linked in this newsletter, please feel free to contact us. We’ll try to help.

Thank You for Your Support