Medicare Advantage Denied My Dying Mom a Bed
How conglomerates are making health care for the elderly worse.
By Sean Morrow, More Perfect Union
We don’t need to tell you the American health care system is broken. But I want to talk about one particularly egregious way health insurance companies have managed to make this system even worse.
In May 2023, my mom was suffering from late-stage cancer and staying in a rehab nursing facility while we tried to figure out the next steps in her care plan.
We had a lot of difficult choices to make when one more got added: a billing administrator at the nursing facility approached me to let me know that my mom’s Aetna Medicare Advantage plan wouldn’t cover her stay anymore.
This didn’t make sense to me — Medicare Advantage is a privatized add-on to Medicare that was supposed to provide better care. But now, our only options were to bring her home—she could barely walk and was on an IV drip, needing constant medical care—or to get rid of her Medicare Advantage plan and switch back to regular Medicare, the basic public plan would’ve paid for her continued stay.
It ended up not mattering: she died before Aetna could throw her on the street.
You can watch the above video for more information about Medicare Advantage and all of the ways private insurance has squeezed families like mine. But here’s the thing: you can save your elderly loved ones from the harm that may be wrought by the next administration right now by using open enrollment, which ends Dec. 7.
Medicare vs. Medicare Advantage
When you get old enough — 65 — you are eligible for Medicare. Medicare has four parts: A, B, C and D.
Medicare Part A is completely free, it’s what you paid for in taxes for working all those years. It covers hospital visits. Medicare Part B is an optional add-on and costs around $175 a month. It covers preventative care and necessary procedures.
A and B are fully administered by the government, and the vast majority of taxpayer money and that monthly payment that funds them go to actually spending on health care: 98.6%. The other 1.4% goes towards paying for the people who literally work for Medicare, processing paperwork and so on.
Part C is Medicare Advantage, which is not administered by the government but rather by private insurance companies like Aetna, who are paid by the government to run the program. It’s heavily advertised by traditional means — TV ads featuring celebrities like William Shatner — and at CVS pharmacies, which owns Aetna, there’s a little quiz about health care options that always seem to point you in the direction of purchasing an Aetna Medicare Advantage plan.
Taxpayers are getting fleeced
But Medicare Advantage does not save taxpayer money; it’s more expensive, costing the public between $300 and $1,400 more per patient than traditional Medicare, according to a study by the health care nonprofit Kaiser Family Foundation. Tools like health risk assessments are misused by Medicare Advantage companies to pump up their payments from the federal government to the tune of billions of dollars a year, the federal government’s watchdog on Medicare issues reported in October.
And Medicare Advantage creates even more hoops for patients and their families, including all of the trappings of private insurance such as limited provider networks (versus being able to see any doctor who accepts Medicare).
A KFF report in August found that Medicare Advantage plans denied more than 3 million prior authorization requests in 2022 — or more than 7 percent of all requests they received. For example: whereas Medicare Advantage denied my mom’s nursing facility stay, traditional Medicare would have said yes. While just 1.4 percent of traditional Medicare costs goes to administrative overhead, it’s more than 10 times that amount for Medicare Advantage.
And in the coming years, Medicare Advantage could become an even bigger part of our health care system. The team assembled by President-elect Donald Trump includes Mehmet Oz, the TV doctor-turned-politician who’s been nominated to run the Center for Medicare and Medicaid Services (CMS). Oz has repeatedly promoted Medicare Advantage and even suggested, in 2020, a “Medicare Advantage for All” plan that would move most Americans onto a plan, funded by a 20 percent payroll tax.
For now, however, access to traditional Medicare is protected. And if you’re reading this before Dec. 8, open enrollment is still ongoing — you can go to Medicare.gov and select the best plan for yourself or your loved ones.