Don’t trust the insurance industry “News” about Medicare Advantage

Deb Gordon’s Forbes article titled 88% of Medicare Advantage enrollees are satisfied with their health insurance, new survey shows is more of an industry press release than bona fide news. The problem starts with the headline, which leads readers to believe that 88 percent of all enrollees are satisfied with their Medicare Advantage (MA) plans, according to a new study. In fact, the “new study” that the whole story is based on was conducted by an insurance company called E-Health that sells Medicare Advantage plans!

Unlike other studies cited by journalists, this was not conducted scientifically using a random sample of the general MA population whose attitudes it aims to analyze. In this case, it is exactly the opposite. “The findings presented in this report are based on a voluntary survey of Medicare beneficiaries enrolled in Medicare Advantage plans purchased through the eHealth website,” E-Health says.

In other words, the 88% figure is not truly representative of all Medicare Advantage participants, and certainly not of all Medicare beneficiaries in general. This simply means that 88% of the company’s own customers who voluntarily responded to the survey responded that they were satisfied with their MA plans. It’s a bit like your employer asking you if you’re happy with your job.

Customers who have negative feelings about their insurance plan are unlikely to volunteer to answer a survey from their insurer. Enrollees with positive feedback about the company were much more likely to share their feelings in a survey, with 88% being “satisfied with their plans.” The same is true of 86% who told E-Health they would recommend Medicare Advantage to a friend or family member, and 61% who said they prefer MA over traditional Medicare.

This leads to another problem with the study and Gordon’s coverage of it. The wording of the questions is not entirely neutral. As the Gallup organization points out, “differences in the wording of questions on a particular topic can change how people respond.” It’s not hard to see how some of the eHealth survey questions would get the respondent to answer the way the company wants them to:

“Do you think Medicare Advantage is a good example of cooperation between government and private enterprise?”

“How satisfied are you with your Medicare Advantage plan?”

“Would you recommend Medicare Advantage to family or friends?”

This may be appropriate for an internal customer satisfaction survey, but not for a survey that will form the basis of a journalistic piece. Why does this matter? Because the public is already subjected to millions of dollars of advertising and propaganda from the Medicare Advantage industry – including those famous TV commercials featuring celebrities like Joe Namath and Jimmy Walker. In contrast, traditional Medicare does not run marketing ads and during the Trump administration was underemphasized in government enrollment materials against Medicare Advantage.

Naturally, the industry’s advertising and propaganda machine doesn’t include the disadvantages of Medicare Advantage—which can be significant. Medicare Advantage offers HMO-like plans with limited provider networks, giving enrollees fewer options for care. They may not even be able to visit their favorite doctor or specialist without paying for it themselves. And MA plans’ marketing materials don’t always disclose important details that could affect access to care or coverage limits.

In fact, the HHS inspector general’s office issued a report in April showing that some MA plans are denying “medically necessary” claims and prior authorizations that should be covered by Medicare rules. The motive appears to be to reduce costs at the expense of patient care.

Medicare Advantage plans were created in 2003, allowing private insurers to compete with the traditional, federally run Medicare program, under the assumption that the plans could provide the same, if not better, level of care more cost-effectively. The exact opposite happened. Investigators have caught some MA plans overbilling the government by billions of dollars:

According to MedPAC, a government watchdog panel, the federal government made $12 billion in “excess payments” to Medicare Advantage plans in 2020. MedPAC predicts that figure will rise to $16 billion next year. – Right to Know, 6/10/22

Meanwhile, federal investigators are looking into allegations that some MA plans billed the Medicare program for patient care based on “outdated or inappropriate” diagnoses to make more money. Medicare Advantage plans have long been accused of “upcoding,” meaning “billing for more severe and costly diagnoses or procedures than (were) diagnosed or performed.”

The Forbes article briefly touches on some of these claims, but ultimately dismisses them. “There’s always room for improvement,” writes Deb Gordon, as if allegations of fraud and wrongful denials of patient claims were minor inconveniences. She then quotes a senior eHealth executive:

“It’s important to listen to the user and find out what works and what doesn’t. As our report shows, for a strong majority, affordability and convenience trump other considerations.” – Bob Rees, Vice President of Medicare eHealth Sales

The combined effect of the misleading headline, understating serious allegations against MA plans, and presenting the study as anything but propaganda amounts to skimming the Medicare Advantage program at a time when it is under growing—and appropriate—scrutiny. Older Americans considering their best options for Medicare coverage should take a hard look at the facts and question industry propaganda masquerading as journalism.

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