Don’t Trust Insurance Industry “News” about Medicare Advantage
Deb Gordon’s piece in Forbes entitled, 88% Of Medicare Advantage Enrollees Are Happy With Their Health Insurance, New Study Shows, is more like an industry press release than a bona fide news story. The problem begins with the headline, which leads readers to believe that 88% of all enrollees are happy with their Medicare Advantage (MA) plans, according to a new study. In fact, the “new study” on which the entire story is based was conducted by an insurance company called E-Health, which sells Medicare Advantage plans!
Unlike other surveys cited by journalists, this one was not conducted scientifically using a random sample of the general MA population whose attitudes it purports to analyze. It’s quite the opposite in this case. “The findings presented in this report are based on a voluntary survey of Medicare beneficiaries enrolled in Medicare Advantage plans purchased through eHealth’s website,” says E-Health.
In other words, the 88% figure is not truly representative of all Medicare Advantage enrollees and certainly not of all Medicare beneficiaries as a whole. It merely means that 88% of the company’s own customers who volunteered to answer the survey responded that they were happy with their MA plans. That is a bit like your employer asking you if you are happy with your job.
Customers who hold negative feelings about their insurance plan are unlikely to volunteer to answer a survey from their insurer. The enrollees with positive feedback for the company are much more likely to share their feelings in a survey, like the 88% who are “happy with their plans.” Ditto for the 86% who told E-Health that they would recommend Medicare Advantage to a friend or family member and the 61% who said they preferred MA over traditional Medicare.
This gets to another problem with the survey and Gordon’s coverage of it. The phrasing of the questions is not exactly neutral. As the Gallup organization points out, “differences in question wording on a specific topic can make a difference in how people respond.” It’s not hard to see how some of the e-Health survey’s questions would lead the respondent to answer the way the company wants:
“In your opinion, is Medicare Advantage 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?”
These might be okay for an internal customer satisfaction survey, but not for a survey that is going to be the basis for a piece of journalism. Why does this matter? Because the public already is subjected to millions of dollars of advertising and propaganda from the Medicare Advantage industry – including those famous tv ads featuring celebrities like Joe Namath and Jimmy Walker. By contrast, traditional Medicare does not run marketing ads and, during the Trump administration, was under-emphasized in government enrollment materials vs. Medicare Advantage.
Naturally, the industry’s advertising and propaganda machine does not include the disadvantages of Medicare Advantage – which can be substantial. Medicare Advantage offers HMO-like plans with limited networks of providers, giving enrollees fewer options for care. They may not even be able to see their favorite physician or specialist without paying for it themselves. And MA plans’ marketing materials do not always disclose crucial details that might 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 pre-authorizations that should be covered under Medicare rules. The motive seems to be reducing outlays 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. Quite the opposite has happened. Investigators have caught some MA plans overbilling the government by billions of dollars:
According to MedPAC, a government watchdog panel, the federal government incurred $12 billion in “excess payments” to Medicare Advantage plans in 2020. MedPAC projected the figure will swell to $16 billion next year. – Entitled to Know, 6/10/22
Meanwhile, federal investigators are probing allegations that some MA plans are billing the Medicare program for patient care based on “outdated or irrelevant” diagnoses, in order to make more money. Medicare Advantage plans have long been accused of “upcoding,” which means “submitting bills for more severe and expensive diagnoses or procedures than (were) diagnosed or performed.”
The Forbes article briefly touches upon some of these allegations, but in the end brushes them off. “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 high-ranking executive of e-Health:
“It’s important to listen to the consumer and understand what works and what doesn’t. As shown in our report, for the strong majority, affordability and convenience trump other considerations.” – Bob Rees, e-Health Vice President of Medicare Sales
The combined effect of the misleading headline, the understatement of serious allegations against MA plans, and the presentation of the survey as anything but propaganda, amounts to a whitewashing of the Medicare Advantage program at a time when it is coming 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 posing as journalism.