This year’s Medicare open enrollment season – which began October 15th and runs through December 7th – should come with the warning: “Buyer Beware.” The Trump administration and its allies in Congress have made health coverage less affordable and accessible by prioritizing insurance company profits — especially when it comes to the privately-run Medicare Advantage (MA) program.
More than half of Medicare patients are enrolled in Advantage plans, unaware of the major Disadvantages they may discover when it’s already too late. These include limited networks of providers (their own doctors may not participate in these plans), sudden withdrawal from certain markets, and frequent denials of coverage for procedures and care their doctors order. By the time MA patients realize the downside of these plans, it may be difficult for them to switch to traditional Medicare.
Traditional Medicare isn’t perfect. It doesn’t yet cover basic dental, vision, and hearing care – something President Biden tried to add in his Build Back Better Act that was scuttled on Capitol Hill. We still advocate for those coverages as they are important to senior’s overall health. But traditional Medicare offers a much wider network of doctors, hospitals, and other providers – regardless of where patients live. In traditional Medicare, coverage decisions are made without the profit motive that is built into Medicare Advantage — and, unlike MA, the program is administered with minimal overhead. Data from the Congressional Budget Office indicates that “private insurance is increasingly less efficient than Medicare.”
One reason MA has captured a growing share of the market is its misleading advertising, with celebrity pitchmen promising lower premiums and extra goodies – while most enrollees are unaware they are joining a glorified HMO with limited choices. The Biden administration began cracking down on MA’s deceptive ad practices, but next year the Trump administration will be rolling back several marketing safeguards.
“Medicare Advantage plans are being given more room to market aggressively at the very moment that patients face higher premiums, more paperwork, and tighter eligibility rules,” said Anne Montgomery, NCPSSM’s senior health policy expert. “That imbalance could leave people with less coverage, higher costs, and fewer places to turn for care.”
Dynasty’s William Devane in a 2023 Medicare Advantage ad
Medicare Advantage was supposed to provide coverage more efficiently than traditional (or “Original”) Medicare — and save the government money. The opposite has happened. MA is costing taxpayers more per patient, partly because insurers have been overbilling the government to the tune of billions of dollars a year.
The Trump administration has talked about clamping down on MA excesses, but at the same time is rewarding Big Insurance giants like United Health Care, Aetna, and Cigna with more cash. The administration gifted MA insurers a 5.1% payment increase in 2026, far above the 2.2% increase initially proposed under the Biden administration.
In 2027, the administration landed on a 2.48% increase for 2027. In total, these decisions will unlock an additional $38 billion in payments for MA providers who are essentially bilking the federal government and Medicare patients at the same time. The cruel irony is that even this lobbyist-stamped infusion of cash is still not enough to prevent insurers from pulling out of some markets entirely(claiming they can’t make enough money),completely stranding Medicare Advantage patients. Those patients will be forced to find new plans during this year’s enrollment period.
In sum: Trump and the GOP have done everything they can do to make health coverage less accessible and affordable for people of all ages, including seniors. Beginning in 2027, the Medicaid cuts and work requirements enacted in Trump’s “Big, Ugly Bill” will take full effect, threatening coverage for many adults (including ‘near seniors’ aged 55-65) who receive coverage through the Affordable Care Act (ACA). Trump/GOP healthcare policies are projected to strip millions of Americans of health coverage in the coming years.
There are also signs that the Trump regime is trying to make traditional Medicare more like Medicare Advantage. Last year it announced a pilot program to use AI bots for determining prior authorizations in traditional Medicare. In July, Republicans blocked a Democratic-led effort to prohibit this practice, which MA plans have been using for a few years now.
“Rather than having trained medical reviewers assess whether a doctor-prescribed treatment or service is necessary, an artificial intelligence algorithm would apparently decide whether Medicare will pay for it. That is scary for beneficiaries. If Medicare denies payment, patients could be left to cover the cost out of pocket.” – Anne Montgomery on the “You Earned This!” podcast
Health care advocates advise that everyone should at least take stock of and review their Medicare plan — the open enrollment period is not only for people who know they want to switch plans. Even beneficiaries who like their current coverage should review their Annual Notice of Change and other plan materials, because plans can change from year to year, especially in this political environment.
When comparing options, we encourage beneficiaries to check:
*Monthly premiums, deductibles, copays, and out-of-pocket maximums;
*Whether their doctors, hospitals, and other providers are in network;
*Whether their prescriptions are covered, and whether they require prior authorization or other restrictions;
*Whether their preferred pharmacy is in the plan’s preferred network;
*The actual limits and costs of supplemental benefits such as dental, vision, and hearing coverage.
A plan that looks inexpensive on paper can become costly if it does not cover certain medications, excludes your preferred providers, or requires burdensome approvals for necessary care. For more information, beneficiaries can call 1-800-MEDICARE, use the Medicare Plan Finder at Medicare.gov, or contact their State Health Insurance Assistance Program (SHIP) for free advice. Setting some time aside to review the options now can prevent unwelcome surprises in 2027.
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Read some of our past blogs on Medicare Advantage HERE
