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Introduction to Medicare Advantage Plans

We are currently in the Medicare open enrollment period and expect an increase in advertisements from Advantage scammers in the coming months. It’s essential to be cautious and aware of these ads’ true nature and beneficiaries.

President George W. Bush and Republicans (along with a few corrupt Democrats) in Congress established the Medicare Advantage program in 2003 to direct billions of taxpayer dollars to for-profit insurance companies.

Origins and Criticisms of Medicare Advantage

Some companies and their executives channel a portion of their profits to politicians through the Citizens United legalized bribery loophole, which five Supreme Court Republicans established. This loophole costs Americans over $140 billion annually, exceeding the entire Medicare Part B or Part D program budget. These unethical practices deplete the Medicare trust fund and trap unsuspecting seniors in private insurance programs where they often face denials for life-saving care.

Financial Impact of Medicare Advantage

Traditional Medicare settles bills as they arise, while Medicare Advantage insurance companies receive a fixed amount per enrollee each year, irrespective of the actual costs incurred for each individual.

The Medicare Advantage programs can be very profitable for CEOs and shareholders when they deny paying for care, which happens frequently. Many people who sign up for Advantage programs need to be made aware of this and don’t need to realize the potential risks if they become seriously ill.

Furthermore, suppose people try to switch back to traditional Medicare after realizing they’ve been misled. In that case, the insurance companies may refuse to provide them with Medigap plans, which cover the 20% gap in traditional Medicare. While they cannot refuse to provide Medigap plans when you first sign up at age 65, getting back on conventional Medicare can be challenging if you switch to privatized Medicare Advantage. Physicians for a National Health Program (PNHP) recently published a report highlighting the extent of Medicare Advantage rip-offs, which affect both individual customers and Medicare itself. This is information that every American should be aware of. (The Incidental Economist. https://theincidentaleconomist.com/wordpress/2011/12/03/)

The report “Our Payments, Their Profits” reveals that Medicare Advantage overcharges taxpayers by at least 22% or $88 billion annually, potentially reaching up to 35% or $140 billion based on 2022 spending. This could fully fund other crucial aspects of Medicare and Medicaid. Medicare Advantage, or MA or Medicare Part C, is a privately administered insurance program that receives a lump sum from the government to manage patient care, unlike Traditional Medicare’s fee-for-service structure.

Differences Between Medicare Advantage and Traditional Medicare

With Traditional Medicare and a Medigap plan, patients directly communicate with their healthcare providers, and Medicare handles the billing. However, with Medicare Advantage, the insurance company receives a lump-sum payment and retains the difference between what they receive and the payout. They may interfere with treatment decisions and often pressure patients to pay out-of-pocket. This has led to some hospitals and doctor groups refusing to accept Medicare Advantage patients.

They decided because Medicare Advantage insurance companies turned down over $75 million worth of services and procedures that their physicians had recommended to their patients. In many cases, Scripps had already provided the care and is now stuck with the bills the Advantage companies refuse to pay. (The Incidental Economist. https://theincidentaleconomist.com/wordpress/2011/12/03)

Impact on Healthcare Providers

Scripps CEO Chris Van Gorder told MedPage Today, “We are a patient care organization and not a patient denial organization, and, in many ways, the managed care model has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations, and administrative processes have become a big issue for physicians and hospitals…” (Medicare Advantage: The Scam You Can’t Afford to Ignore | Common Dreams. https://www.commondreams.org/opinion/medicare-advantage-is-a-scam)

Mayo Clinic in Florida and Arizona will no longer accept Medicare Advantage. The Medicare Advantage program does a disservice to healthcare providers and participants who become ill and hinders Americans from receiving enhanced benefits through traditional Medicare.

Potential Solutions and Alternatives

The report from PNHP indicates that providing comprehensive vision, dental, and hearing benefits to all Medicare recipients would cost the system approximately $84 billion annually. However, the Medicare system is burdened with at least that amount in overpayments to Medicare Advantage providers—overpayments that do not benefit health and only increase companies’ profits.

The health insurance industry has made excess profits of a hundred billion dollars, with the former CEO of UnitedHealth earning over $1.5 billion. As Schakowsky, Khanna, and Pocan point out, “Only Medicare is Medicare.” Don’t be deceived by the Medicare Advantage scam. Now that you know, please pass it on and help safeguard someone else’s health!

Author Barby Ingle, VP International Pain Foundation 2026-27

Published by Barby Ingle For Arizona