By H. Dixon Turner, M.D.
Portsmouth (N.H.) Herald, Letters, Nov. 6, 2024
To the Editor:
Itās that time of year again, namely the annual Medicare Enrollment period. At times it seems that every other commercial on TV is for another Medicare Advantage plan. I would urge people to be very cautious when considering enrolling for one of these plans as opposed to remaining in Traditional Medicare. A report by the organization, Physicians for a National Health Program, titled āOur Payments Their Profitsā revealed that insurance companies offering Medicare Advantage plans can āearnā profits that are estimated at 88 to 140 Billion dollars every year!! That is money from the Medicare Trust Fund which is NOT going to direct medical care for seniors, but instead is lining the pockets of these companies.
Medicare Advantage (MA) companies reap these exorbitant profits through various means: First, MA companies charge overhead expenses averaging 15-20% whereas Traditional Medicare has an overhead of 2-3%. MA companies aim to enroll healthier patients than the average Medicare recipient and they function like an HMO, often with a very limited panel of providers. Prior approval is often required for procedures which result in delays or denials of necessary care–services which would normally be covered under Traditional Medicare. Upcoding of patient diagnoses frequently occurs by adding on non-existent diagnoses or by exaggerating the severity of existing diagnoses to increase payments. Finally, if a patient does develop a serious illness, such as cancer, those patients ā either voluntarily or involuntarily ā are often dropped from the MA program.
An additional problem which may occur when patients switch from a MA plan back to Traditional Medicare is that they may not be able to get a Medigap or supplemental insurance policy at all or only at a very high cost. Currently only 4 states (Connecticut, New York, Massachusetts and Maine) mandate that Medigap plans must be offered at community rates. Attempts to pass such a mandate in NH failed to pass in the legislature this year.
The āOur Payments Their Profitsā report estimates that Medicare and Medicaid could cover dental, hearing and vision benefits for ALL Medicare and Medicaid recipients for $80 billion per year, which is less than the lowest estimate of the profits which MA companies are projected to receive this year. These huge profits very likely will rapidly deplete and could bankrupt the Medicare Trust Fund.
Thus, I believe that Medicare Advantage plans are a huge rip off foisted on the American public and should be avoided. I encourage seniors to sign up for or to stick with Traditional Medicare. Also, please lobby our national representatives to terminate or restrict these MA plans and seek instead to increase the benefits currently available under Traditional Medicare.
Dr. H. Dixon Turner is a member of the Granite State (N.H.) chapter of Physicians for a National Health program.