Congresswoman explains Medicare Advantage Scam in five minutes.

[Jacson6]

[Walleye]

1. That's the most informative and clearest explanation I've heard. She's really smart.

I wonder if she’s the most intelligent member of Congress at this point. She is extremely good at her job

[patphil]

2. There are so many commercials for Medicare Advantage that it made me wonder who had the advantage.

Turns out it was the Insurance companies.
I never did sign up for it...didn't pass the smell test.

[dflprincess]

20. The first clue there is something wrong with Medicare Advantage is the way the insurance companies push it

They aren't doing that because they love us and want us to be healthy.

And note how rarely they mention supplement plans that go with traditional Medicare.

[Silent Type]

3. I hope she explained that most of the 53% who choose MA do so because they cannot afford the up front premiums

for a supplement and drug plan, while forgoing $100 os so monthly for grocery/OTC cards, a thousand or so for limited dental, etc.

Until Congress gets off it’s rear and improves original Medicare, that 54% will continue growing.

[Auggie]

4. The savings the Congresswoman advocates could go towards lowering rates

[Silent Type]

7. Sounds like typical "you are being fooled and we know what is best for you." I'd just as soon MA didn't exist.

But until Congress improves original Medicare people are going to look at the "savings" of $3000 to $5000 a years and say that can't do without it.

One good thing is that CMS is now going to audit MA plans at least annually, and they've started programs to review denials. These are things CMS has had authority to do for years, but haven't.

https://www.cms.gov/newsroom/press-releases/cms-rolls-out-aggressive-strategy-enhance-and-accelerate-medicare-advantage-audits

[Auggie]

11. I had cancer. Medicare paid for everything,

aside from the annual deductible of my Plan G.

I picked my own health care team and was cured without surgery by some of the best cancer specialists and innovative treatment plans in California.

Those MA premium savings you mention don’t take co-pays or deductibles into account. This up charge amendment may not be perfect, but it’s better than nothing. No way MA is going away — the health care insurance lobby is too strong. I would like to see better education on the subject, akin to the way AOC did it.

This amendment will be a tough one to pass.

[Silent Type]

14. Friend died with cancer after a 8 week stay in hospital, hospice, tests and more test, surgeries, etc. MA paid everythin

without denials, etc.

We need universal healthcare, but until voters go for people who will do it, we are stuck with this cruddy system.

I still have original Medicare, but I will probably have to go MA in next few years. I don't go to docs often, and I'm at an age where I probably wouldn't drive all over the city to see a bunch of docs if I can't make it anymore.

Understand, I'm not opposed to original Medicare. I am opposed to those who want to take the choice away from the majority of beneficiaries who think MA is best for them. My guess is, we'll still be debating this 20 years from now, with nothing of consequence enacted.

[Envirogal]

5. Always been a scam.

Well they better not get sick then cause they really won’t be able to afford groceries then. You get what you pay for, especially when you dance with the corporate devil.

Congress created MA and the public was asleep at the wheel. But when you see Corporations advertising so heavily for a “government” program, people should know it’s a grift.

[Silent Type]

8. Congress created ACA and Part D, both use private insurers as the basis for coverage. Do we want to repeal those too?

Agree that was a mistake, but until someone comes up with something better, I'm not for taking benefits away from people because private insurers are involved. Heck they are involved in Medicare too. For most matters, if you have a question about Medicare, you are talking to an employee of an insurance company subsidiary who contracts with CMS to process claims, perform audits, answer beneficiary questions, etc.

[JohnSJ]

47. also the supplemental plans under Medicare are through private insurers, which cover those costs that

Medicare part A/B do not cover, and that 20-30% can be quite substantial.

[misanthrope]

12. Simple calculus: If it wasn't a windfall

Then corporations wouldn’t be spending so heavily on the advertising.

[Silent Type]

15. Windfall to insurers AND to the majority of beneficiaries who believe the "extras" are better for them.

[cadoman]

41. I see so many people scammed out of their Medicare and Social Security

It's a program that's inherently built on the premise that we all might need something to fall back on some day, particularly those prone to making bad decisions.

And then we allow them to immediately go out and get scammed into spending the money that was supposed to be the fallback program.

[Beartracks]

28. Congress COULD improve Medicare, but Republicans are too invested in their own "government doesn't work" myth. n/t

[Silent Type]

30. This has been going on for 50+ years. Not sure we can pin it totally on Republicans.

[Skittles]

33. Medicare COULD be improved

using the money wasted on "Advantage" scams

[DownriverDem]

36. I agree & am so tired

of folks not realizing why folks choose MAs.

[HuskiesHowls]

37. I have a Part C plan, and my wife will be going on it at the end of the year

Before I retired, my employer was paying for our supplemental and prescription plans(Blue Cross). When I retired, I did the math, and realized that I couldn't afford either of them for me. My MA plan has an out-of-pocket max of $3,600, and the premiums for the supplemental and prescription plans would have cost me over $4,000.

Right now, the two plans for my wife are almost $5,000 annually, and that is becoming a major problem, since we're getting by mainly on SS. She'll be going on the same MA plan I have, with that max out-of-pocket of $3,600.

Although I would prefer that both of us have the supplemental insurance, I simply cannot afford it anymore.

i know, the next statement is going to be "why not find a cheaper plan?", I really like the Blue Cross plans. Before I retired, I had several surgeries, and there was never a question about a claim, and absolutely no problems with any medication prescribed for us.

[brush]

6. My understanding has always been Medicare A and B, regular Medicare, pays 80% of hospital bills and you...

have to pay the rest. Medicare Advantage programs confuse it all and seem like a good deal, but like AOC says in the video, when you really meed major care, that's when the shock comes in.

I wish she had went into the 80% clause.

Another thing are the TV ads and calls hyping the need sigh up fast before the deadline runs out. These ads seem to run all year...a sign of a scam to me.

[dflprincess]

23. You need to buy a supplement policy to cover the 20% traditional Medicare doesn't cover

Plus a Part D policy. There is a variety of supplements available but none of them cover dental, vision, or hearing. The insurance companies price a lot of these gap policies higher than what they charge for Advantage plans. I can understand why people looking at their monthly expenses fall for this scam. I plan to stick with traditional Medicare as long as I can, but I worry the day may come when I have to go to Advantage to save a few dollars in the short term.

[MIButterfly]

27. My supplemental plan covers dental, hearing and vision.

Not 100%, but it's better than nothing. I will stick with traditional Medicare, even though I think Part D is the biggest rip-off in the world. I'm good with the rest of it.

My mother was on Medicare and had the same supplemental plan I have now (Blue Cross). She had lung cancer, COPD and AFib. She went through one round of chemo and two rounds of radiation. She was in the hospital twice and spent over four weeks in rehab. One of her "Explanation of Benefits" statements was 12 pages long and the bottom line said she owed 0.

I have a friend who has Medicare Advantage and she just raves about all the benefits she gets for next to nothing. She's had both hips replaced. So who knows? I just don't trust Medicare Advantage. Anything they push on us that hard has to benefit them more than it'll benefit us. My two cents.

[LastLiberal in PalmSprings]

46. I had Aetna Advantage for 20 years. I'm using SCAN now.

I've had both knees, hips and shoulders replaced. The out-of-pocket cost was $0 for each operation and following hospital stay. My annual meds were less than $150 under Aetna and projected to be $0 under SCAN.

Quality of care has been excellent, although that may be because I live in the Palm Springs, CA, area, which features the Eisenhower Medical Center and a variety of top specialists (although than may be partly due to the 100 championship-level golf courses in the area).

My first major operation -- a hip replacement -- was done by a leading orthopedic surgeon (Dr. Douglas Roger in Palm Springs) who completed the procedure in 28 minutes, operating through a four inch incision in the side of my hip. I think it was a procedure he had personally developed, because he was giddy about the results, which is not what I expected from a doctor who had zero bedside manner. That afternoon I walked 100 yards without a walker, cane or pain. Five stars.

Unfortunately, his medical group dropped out of the medical group Aetna uses, and my second procedure was done using the "normal" technique, which led to a longer operation and recovery time. The end results were the same; I would have preferred the former, but I didn't have the money to pay the 20% Medicare doesn't cover.

Overall, I was satisfied with Aetna's MA. I started SCAN on Jan 1, so we'll see what happens. They both use the same medical group (Desert Oasis Healthcare), so I've kept my primary care doctor.

One thing I've found interesting is that pharmacists don't seem to understand that MA isn't Medicare, but a private medical insurance policy.

Not having a reasonable dental benefit is a bummer, but when I wanted implants I just drove to Tijuana and got the procedure done for half of the U.S. rate.

[JohnSJ]

48. I am not sure what kind of supplemental plan you are on, but Medigap plans are supplemental polices that

pay for out-of-pocket costs not covered by Medicare, and as far as I am aware, Medicare does not cover standard dental or vision care.

F was the best Supplemental, which is now no longer offered, but G is the next best.

Part D is for drugs, and you are right, many times the co-payments for Part D are higher than if you went with something like GoodRx. However, if someone needs one of the newer expensive drugs Part D, if it is an approved Drug, Part D is better than nothing, and will cover a substantial amount.

As I said have never heard of a Medi-gap plan that covers standard vision coverage for things like glasses, and standard dental work like crowns or root cannels.

Vision issues related to cataracts or eye disease conditions will be covered, and in some cases some dental conditions, but generally no.

What supplemental plan are you on if I might ask?

[MIButterfly]

52. Blue Cross.

I had Blue Cross through my employer when I was working and I liked it so that's what I chose for my Medigap. My dentist is not in their network so I have to pay 50%. As for vision, I pay pretty much the same for the exam and glasses that I did with my vision insurance when I was working.

My card says Dental Vision Hearing package right on it. I don’t know if that's an option or what. I just know I have it.

[JohnSJ]

53. Thanks MIButterfly. I have a supplemental F through United Healthcare, but I have separate dental insurance.

Blue Cross is a good company. It sounds like your vision and dental are separate policies through Blue Cross, distinct from the Blue Cross supplemental Medigap. Not sure though. Moot point anyway because it seems to take care of your needs.

[brush]

34. Yeah, it's a dilemna and MA plans with their constant advertising purposely confuse people.

[KentuckyWoman]

9. I am on the GM UAW advantage plan

My total out of pocket costs for all medical related anything in 2024 was $2116 with UAW advantage Humana.

On Medicare my costs
Medicare $174.70 = 2096.40 yr
Supplement $357.12 = 4285.44 yr (how much ends up profits?)
Drug plan $46.50 = 558 yr

MY costs on Medicare = $8023 including out of pocket, copays etc.
MY costs on Advantage = $2116


If they want to kill the advantage market, they'll have to fix Medicare first because the math is what it is.

[Silent Type]

31. Exactly. Yet all we do is gripe about MA and want to take it away from people who did their own assessment.

[gulliver]

54. People forget about the MA MOOP (maximum out of pocket) and vision and dental

I think an MA plan with a low MOOP (like $2K or less) and a big network seems to me like it's hard to beat, especially if it is created as part of a retirement package by a trustworthy institution like the UAW. I had a close relative go through a long hospitalization with surgery, medication, and many ambulance trips. Total out-of-pocket was the MOOP of around $2K.

This relative's plan also includes dental care and vision care, unlike straight Medicare. And there is no premium.

[KentuckyWoman]

55. UAW Humana does not include vision/dental/hearing BUT

Tru Hearing -- aids are expensive but coming down in price. I did save about $500 using the benefit when I replaced mine. 2 yrs of maintenance so that helps too.

Delta Dental - cleanings 2X a year are free with Xrays. I had to have something extra done that was not covered but was discounted 50% ... supposedly.

Vision - UAW Humana does cover medical eye visits but not vision. There is a separate vision plan but I don't remember who. It is worthless for me. I go to Costco.

We recently got OTC benefit. A card with $300 on it for over the counter medicines from an approved list. I have not yet figured out if I can use it anywhere other than CVS - which is a real pain because they aren't big in my area.

[gulliver]

57. That's good imo.

My relative doesn't get an OTC drug benefit but does get basic dental limited to about $1.5K per year. It seems like a pretty good plan to me. Much cheaper for drugs and premium than we had using Medicare plus supplemental plans. Drugs are cheaper under MA, and the premium is zero.

[JMCKUSICK]

10. Did the Amendment pass?

If no, we need to be screaming about that!

[Warpy]

16. Probably not

Corporate waste, fraud and abuse are the name of the game for Republicans and some Democrats (hate to admit that) and profiteering off the old and sick is the same to them as profiteering off the fears that drive the Pentagon budget.

I've finally aged out of eligibility for Medicare Scamvantage and it's a relief. Their marketing is intense and relentless. I used to leave my landline unplugged for weeks at a time because of frequent, hard sell phone calls.

I will be delighted if the Democrats manage to end the fraudulent billing and make them less profitable. While they once looked like a great idea on paper, they are terrible in practice.

[moonscape]

24. Aged out? When do they stop accepting?

I’m Original Medicare and yes, the marketing is relentless. I’m 74. When will I be free?

[Warpy]

58. I don't think they want anyone over 75

because that's when I stopped having so many hard sell assholes to hang up on.

[ashredux]

13. To anyone who's even thinking of buying Medicare advantage, remember, there is no free lunch!

[Martin68]

17. When my wife and I got free professional help from retired professionals to guide us through the medicare sign up

process, the one message they drove home repeatedly was that Advantage is a scam and is to be avoided it at all cost.

[surfered]

18. NPR says Advantage costs taxpayers more than traditional Medicare.

https://www.npr.org/sections/health-shots/2021/11/11/1054281885/medicare-advantage-overcharges-exploding

[Jacson6]

38. Over a decade ago I ignorantly subscribed to MA.

I had a $20,000 medical bill after having a heart problem.

[Quanto Magnus]

19. And yet....

we are forced into buying Medicare Advantage or get fined for inadequate coverage. I'm still paying off a fine from 2021, because Wellcare was not paying for my meds like they were supposed to, so I dropped them. When I signed up for new insurance with UHC, I get a letter saying I owed hundreds of dollars, because of dropping Wellcare.

[Hotler]

21. Bravo ..... Than you Rep. OC

[AllaN01Bear]

22. just subbed her utube channel

[calimary]

25. AOC seems to be one of the few Congressmembers determined to defend the greater good.

With we could clone her!

[soldierant]

26. The whole point to Advantage

is to eventually privatize Medicare.
And then?

It reminds me of when Sam Walton publicly said that the Walmart business model was to underprice all the other discount chains, and then raise prices.

https://www.youtube.com/results?search_query=you+don%27t+know+what+you+got+till+it%27s+gone

[Silent Type]

32. ACA, Part D, and Part C (signed by Clinton) are all privatized like every major healthcare change in last 30 years.

Should we repeal them too?

[Dark n Stormy Knight]

43. That's exactly what Walmart did.

Unfettered capitalism is full of such problems. People, especially poor people, are of course going to be lured by lower prices or a better deal (as MA plans seem to offer.)

People are can't be expected to investigate or prognisticate that it's a scam. The system ought to protect the people from such schemes.

[soldierant]

44. Amen!

[BoRaGard]

29. Thank you, Rep. AOC!

She is so thoughtful and clear.

[Buddyzbuddy]

35. Loved her presentation.

She is so smart. First you have to understand the complexities of the program and the ways in which we are being taken advantage of and then you make a 5 minute statement explaining it in the simplest way possible and offer a solution.

Thank you, AOC, for not only doing your job but also doing it so spectacularly. Please teach my representative, Norma Torres, to do the same.

You need a bigger constituency. Like the Senate or maybe....


Thank you Jacson6 for bringing this to our attention. The more exposure she gets, the better.

[Demsrule86]

39. I have an Advantage plan. It pay all but $10.00 of part B, There is 0 premium...

And the pharmaceutical plan is excellent. I looked into original Medicare and I can't afford it. That is the truth. Unless you are grandfathered into the decent plans (still more than my plan) or you are extremely low income and can get help. Original Medicare simple doesn't work for many-including me.

[JohnSJ]

49. That is the issue that many don't consider. The premiums for the best Medigap plan F or G can run

about 500-700/ month for two people. Add another 200 to 400/ month for Part B for two people, plus Add another 100 bucks or so for Part D premiums, and vision and dental are not included.

A lot of folks on a fixed income just can't afford that, and a LOT OF FOLKS who aren't on Medicare don't realize that even after paying into Medicare while they were working, they still have to pay a premium for Part B, a premium for a supplemental plan, and a premium for Part D, and dental and vision aren't included.

People can argue until the cows come home why MA plans are not as good or flexible as Medi-gap plans, but the reality is for many in the country it comes down to what people can afford, and for a lot of people Medicare Advantage is sure as heck a lot better than not being covered because you cannot afford the premiums.

[wolfie001]

40. Regular Medicare with a Medicare Supplement

Check the prescription pricing. Mine doesn't charge me anything. Included with the Supplement. Avoid MA if possible!!!

[MichMan]

42. This is why the Democratic platform for 2026 & 2028 needs to eliminate all MA plans

[Celerity]

45. Feds killed plan to curb Medicare Advantage overbilling after industry opposition

https://www.google.com/amp/s/www.cbsnews.com/amp/news/medicare-advantage-overbilling-feds-kill-bill-after-industry-opposition/

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars — only to abruptly back off amid an "uproar" from the industry, newly released court filings show.

The Centers for Medicare & Medicaid Services published the draft regulation in January 2014. The rule would have required health plans, when examining patient's medical records, to identify overpayments by CMS and refund them to the government.

But in May 2014, CMS dropped the idea without any public explanation. Newly released court depositions show that agency officials repeatedly cited concern about pressure from the industry. The 2014 decision by CMS, and events related to it, are at the center of a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group pending in federal court in Los Angeles.

The Justice Department alleges the giant health insurer cheated Medicare out of more than $2 billion by reviewing patients' records to find additional diagnoses, adding revenue while ignoring overcharges that might reduce bills. The company "buried its head in the sand and did nothing but keep the money," DOJ said in a court filing.

snip

[Progressive dog]

50. Why do we play uinto Trump's hands by attacking medicare?

ACA is private insurance, medicaid is also run by insurance companies, original medicare uses insurance companies to actually pay the bills, medicare supplements are private insurance.
Over 50% of Medicare is Medicare advantage--this is by choice of the insured.
.

[Emile]

51. K & R

[gulliver]

56. National health support services should be Medicare Advantage for All plus nutrition and exercise

If we want national health care, the way to do it is to offer a complete vision of a better future system. And that vision needs to sell to the Dr. Jekyll, Mr. Hyde, Pollyanna, and Chicken Little in all of us. That means it has to be more than just accountability, more than just empathy, more than just reassuring. It has to look "damned fool proof."

I think we need to line up with the MAHA kick (weirdly bent as RFK Jr. has made it) along with the "waste, fraud, and abuse" kick. MAHA can drive downstream cost reduction (and suffering and early death as, some might say, a good side effect).