The letter below outlines PSARA’s case for Leveling the Playing Field between Medicare Advantage and Traditional Medicare. Please review our letter to President Biden and sign-on to the letter by using the form at the bottom of the letter.
The Honorable Joseph R. Biden Jr., President of the United States
The White House
1600 Pennsylvania Avenue, N.W.
Washington, DC 20500
Dear President Biden,
We are writing to you because the current practices of Medicare Advantage (MA) insurers are causing serious inequities within the Medicare system, and harming the health and well-being of senior citizens and people with disabilities. We know there are solutions that can fix the inequities and undo these harms.
We agree wholeheartedly with your statement in the December 7, 2023 White House policy announcement that “health care should be a right, not a privilege.”[1] We applaud your December announcement proposing ways for the Center for Medicare and Medicaid Services to “create a more level playing field” by changing the system for Medicare Advantage (MA) payments to “improve payment accuracy, address gaming, and recover overpayments.” The outrageous overpayments to MA insurance companies cost CMS as much as $140 billion in 2023 alone[2] and are increasing dramatically with each passing year.[3]
However, more needs to be done to truly level the playing field between Traditional Medicare (TM) and MA so that Medicare beneficiaries have a financially viable choice between these programs. If we can equalize the cost and benefits of the two programs, many beneficiaries will no longer be forced to choose MA plans simply because those plans cost less up front. Additionally, beneficiaries are currently led to believe that they are getting a better deal with MA since only MA plans are allowed to offer dental, vision, and hearing benefits - although these often prove substandard or even unavailable in practice. Once enrolled in MA plans, beneficiaries encounter prior authorization policies, care delays and denials, and unreasonable network limitations – all of which are known to cause harm and even death.[4] These disturbing practices are a standard feature of MA plans, which now enroll half of beneficiaries, but are not typically seen in TM.
Once lured into MA plans, enrollees are often stuck in them. In most states, if a beneficiary who leaves an MA plan for TM tries to buy the Medigap insurance needed to cover the 20% TM co-pay, the Medigap insurer can charge more or even deny coverage based on the beneficiary’s age or pre-existing conditions. This problem was featured in a 2024 National Public Radio piece[5] titled “Older Americans say they feel trapped in Medicare Advantage plans,” which cited data showing that ~50% of MA enrollees leave their plans within five years, often for another MA plan rather than TM because of the Medigap trap and other cost issues.[6]
Therefore, we urge you to take action on your proposal to “create a more level playing field” by:
1. eliminating the 20% co-pays in Traditional Medicare and capping out-of-pocket expenses;
2. adding benefits to Traditional Medicare, including vision, dental, and hearing;
3. eliminating overpayments and excessive administrative costs in MA; and returning funds lost to insurance company overpayments, fraud, and abuse to the Medicare Trust Fund to help pay for leveling the playing field for Traditional Medicare beneficiaries.
Medicare is a signature earned benefit program that Americans have long viewed favorably. But increasingly seniors and people with disabilities are feeling betrayed by MA programs that provide inferior care. The intention was for MA plans to reduce costs and improve quality, but instead they are drastically depleting the Medicare Trust Fund and creating a lower quality track for those with fewer financial resources. Medicare recipients deserve a fair and equitable choice between a strengthened TM plan or an MA Plan. By truly leveling the Medicare playing field you will secure your legacy as a staunch protector of seniors and the disabled - and ensure the future of a treasured American program.
Sincerely,
cc:
Secretary Xavier Becerra, U.S. Department of Health and Human Services
Chiquita Brooks-La Sure, Administrator
Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services
Senator Chuck Schumer, U. S. Senate Majority Leader
Representative Hakeem S. Jeffries
U.S. House Minority Leader and Leader of the House Democratic Caucus
Senator Elizabeth Warren, U.S. Senate
Representative Pramila Jayapal, U.S. Congress
[4] 1 in 3 doctors has seen prior authorization lead to serious adverse event, Kevin B. O’Reilly, AMA Association website, March 29, 2023, https://www.ama-assn.org/practice-management/prior-authorization/1-3-doctors-has-seen-prior-auth-lead-serious-adverse-event
