Reclaim Medicare from Corporate Greed

TAKE ACTION NOW: Fill out the form below to send an email to your U.S. Senators and Congressperson urging them to sign on to a letter asking President Biden to address issues with Medicare (dis)Advantage and expand Traditional Medicare!

ABOUT MEDICARE ADVANTAGE: Medicare is an essential public program that provides universal health coverage to millions of older Americans and people with disabilities. But Medicare is UNDER ATTACK and being gobbled up by greedy health insurance corporations through a program called Medicare Advantage. Patients on Medicare Advantage experience long wait times and are regularly denied care, and the consequences can be deadly. Corporations that offer Medicare Advantage use dishonest marketing practices to sell their plans, and receive heavy taxpayer subsidies. These corporations are gouging taxpayers and are overpaid by the government by $88 - $140 BILLION dollars each year. This is the largest bait-and-switch in America, and your elected officials need to hear from you ASAP!

Enter your information below, then click “SEND EMAIL” to email your elected officials and urge them to sign this letter! These corporations need to be held accountable and not given a pat on the back by our elected leaders.

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Dear [recipient position will go here] [recipient name will go here],

Your Letter *

I’m reaching out as a constituent and Be A Hero supporter with serious concerns about the Medicare Advantage program. Currently,  a letter is being circulated in the House and Senate, led by Representatives Pramila Jayapal, Rosa DeLauro, Jan Schakowsky, Senators Elizabeth Warren and Sherrod Brown, asking HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure to implement policies addressing major issues with Medicare Advantage.

I am urging you TO SIGN this letter and act swiftly to protect patients on Medicare Advantage.

The letter encourages President Biden, Secretary Becerra and Administrator Brooks-LaSure to implement reforms in four different areas.

PROTECTING PATIENTS ON MEDICARE ADVANTAGE:

Ninety-seven percent of providers report that their patients experienced a delay or denial of care because of the use of prior authorization in Medicare Advantage. The letter urges CMS to strongly enforce regulations pertaining to prior authorization and penalize plans that do not comply.

https://www.mgma.com/getkaiasset/fa2103f5-a2f6-47a1-b467-4748b5007c7e/05.03.2023_PA-in-MA_FINAL.pdf

The increasing use of Artificial Intelligence is also leading to inappropriate denials of care. The letter encourages CMS to develop new regulations that ensure the use of AI does not lead to claim denials that would have been approved in Traditional Medicare.

https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/

Insufficient provider networks are making it harder for patients on Medicare Advantage to get care, resulting in poor patient outcomes. Patients on Medicare Advantage were five times less likely to receive cancer care at a cancer center of excellence compared to patients on Traditional Medicare. Additionally, patients on Medicare Advantage are significantly more likely to die after developing stomach, pancreas or liver cancer compared to patients on Traditional Medicare. Even when patients seek in-network care, the directories they rely on are inaccurate. The letter asks CMS to deem a network sufficient as one that includes any provider who accepts Medicare’s approved rate for services covered under Medicare.

Raoof et al., “Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients.” Journal of Clinical Oncology, 2022.

https://www.finance.senate.gov/imo/media/doc/050323%20Ghost%20Network%20Hearing%20-%20Secret%20Shopper%20Study%20Report.pdf

INCREASING TRANSPARENCY IN MEDICARE ADVANTAGE:

The letter urges CMS to analyze and publicly share data to enable researchers to analyze the efficacy of Medicare Advantage. It seeks to increase transparency related to prior authorization, claim denials, out-of-pocket costs, and enrollment behavior. Additionally, the letter requests that CMS create a centralized database to increase the utility of this data. 

https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES

https://www.kff.org/coronavirus-covid-19/issue-brief/problems-getting-care-due-to-cost-or-paying-medical-bills-among-medicare-beneficiaries/

https://www.kff.org/medicare/press-release/black-medicare-beneficiaries-are-more-likely-than-white-beneficiaries-to-have-cost-related-problems-with-their-health-care-across-both-traditional-medicare-and-in-medicare-advantage-plans/

https://www.gao.gov/products/gao-17-393

REIGNING IN OVERPAYMENTS TO MEDICARE ADVANTAGE PROVIDERS:

Overpayments to Medicare Advantage are estimated to be between $88-$140 billion per year. These overpayments are the result of upcoding, favorable selection, quality bonus payments and induced utilization. The letter makes many recommendations on how to revise the payment methods, such as increasing coding intensity and adopting the Demographic Estimate of Coding Intensity (DECI) model. The letter encourages applying these revisions in a targeted manner in order to hold bad acting insurance corporations accountable.

https://pnhp.org/system/assets/uploads/2024/01/MAOverpaymentReport_Oct2023.pdf

Reducing Medicare Advantage Overpayments. Committee for a Responsible Federal Budget (February 23, 2021)

STRENGTHENING TRADITIONAL MEDICARE:

Many beneficiaries have no real choice between Traditional Medicare and Medicare Advantage. The premiums for supplemental plans that reduce the cost share percentage of Traditional Medicare and offer vision, hearing and dental benefits are too expensive for many older Americans and people with disabilities. Additionally, after someone has been enrolled in a Medicare Advantage plan for a year, they are no longer guaranteed access to supplemental plans, and are often denied or are unable to afford supplemental plans due to preexisting conditions. The letter encourages CMS and the Biden administration to lower Medicare premiums and continue advocating for expanding Medicare benefits to include vision, hearing and dental, while at the same time ensuring an adequate reimbursement for providers. Nearly all of these reforms could be paid for by stopping overpayments to Medicare Advantage providers. 

https://www.cbpp.org/research/informing-the-debate-about-curbing-medicare-advantage-overpayments-0#_ftn11

https://www.crfb.org/blogs/new-evidence-suggests-even-larger-medicare-advantage-overpayments#:~:text=Combining%20these%20estimates%20with%20the,billion%20in%20higher%20Medicare%20premiums

It is for these reasons that I encourage you to sign on to the letter urging Medicare Advantage reforms. These sensible policies will go a long way in protecting your constituents and expanding access to care for all Medicare beneficiaries. 

I urge you to join your colleagues in asking Secretary Becerra and Administrator Brooks-LaSure to take immediate action to protect patients on Medicare Advantage, support efforts to expand and improve Traditional Medicare, recoup overpayments to the insurance corporations that offer Medicare Advantage, and reclaim Medicare from corporate greed.

Sincerely,
[your name will go here]
[your email address will go here] [your location will go here]

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