It’s more than a little ironic that the for-profit Medicare Advantage program – which was supposed to save taxpayers’ money – is actually increasing costs for people in traditional Medicare. Congressional investigators blame this year’s spike in Medicare Part B premiums on Medicare Advantage overbilling the government by billions of dollars.
Fresh reporting from the Wall Street Journal (WSJ) details how those overpayments translated into an estimated $13.4 billion in Part B premium costs in 2025 alone. In other words, every person with traditional Medicare Part B medical insurance is effectively subsidizing excess payments to private insurers. This revelation is only the latest in a series of Medicare Advantage scandals.
Once a darling of conservatives who championed a privatized version of Medicare, MA now faces bipartisan scrutiny. The Joint Economic Committee affirmed that MA insurers are bilking the government using a practice known as “systemic upcoding.” This sketchy and misleading tactic involves exaggerating patients’ diagnoses so that insurers can bill for higher payments. 
We have been sounding the alarm on upcoding for years. Our senior health policy expert, Anne Montgomery, laid out how insurers go about it in a 2023 edition of our “You Earned This” podcast:
“Medicare Advantage plans encourage providers to find every chronic condition and billable diagnosis for each enrollee — far more aggressively than doctors do in traditional Medicare. This upcoding lets them extract higher payments from the government per patient, adding up to massive overpayments.” – Anne Montgomery, NCPSSM
MA’s shady practices extend beyond overbilling. Older TV viewers would be hard-pressed to go 30 minutes without being bombarded by relentless Medicare Advantage ads. These misleading ads have featured mainstays of mid-20th century culture, including Joe Namath, William Shatner, and Jimmy Walker, extolling the ‘benefits’ of Medicare “Part C” (as MA is officially known).
Historically, these TV ads have conflated Medicare Advantage with traditional Medicare, so that viewers may not even know that the traditional version still is an option. They promise low-to-no premiums and extra goodies like gym memberships and free rides to the doctor, without disclosing that MA is like an HMO with limited networks of doctors, onerous ‘prior authorizations’ for care, and hidden out-of-pocket costs.
The Biden administration began cracking down on MA insurers, issuing rules demanding greater transparency and accuracy in advertising. More recently, Reps. Mark Pocan (D-WI), Ro Khanna (D-CA), and Jan Schakowsky (D-IL) re-introduced the “Save Medicare Act,” with similar aims.
“Private, so-called ‘Medicare’ plans run by private insurers undermine traditional Medicare and create confusion. They often leave patients without the benefits they need while overcharging the federal government for corporate profit. This bill makes clear what is – and what is not – Medicare, and ensures this essential program will continue to serve seniors and other Americans for generations to come.” – Rep. Mark Pocan, 3/4/2026
As John Oliver said in his 33 minute takedown of MA last fall: “Honestly, it probably shouldn’t have the word Medicare anywhere near it, because it’s misleading. It’s kind of like the mountain chicken. Picture what a mountain chicken looks like in your head right now. You’re wrong, because it’s this. It’s a ****ing frog!”
While scrutiny intensifies, Medicare Advantage is capturing a growing share of market enrollment, even as Centers for Medicare and Medicaid Services (CMS) proposes stricter guardrails. With overpayments estimated at $76 billion this year alone and major insurers subject to federal investigation, Medicare Advantage faces mounting pressure from both parties to begin putting patients ahead of profits.
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Listen to our podcast episode on Medicare Advantage with NCPSSM senior health policy expert Anne Montgomery HERE