Overpayment, Marketing Abuses, Care Delays and More: Top Priorities for Medicare Advantage Reform

Now is the time to prepare partners and stakeholders for broader mobilization efforts in 2025, to rein in the abuses in the MA program that are driving unnecessary spending and low quality care.
The Medicare Advantage program has rapidly grown over the past few decades and now provides coverage to more than half of eligible Medicare beneficiaries, as of 2023, with that number expected to continue increasing substantially over the next decade. At least 40% of MA funding now comes from the Hospital Insurance trust fund, which is a key source of financing for the entire Medicare program; as such, concerns about the cost and quality of care provided in the program have grown with enrollment. MA is a major driver of Medicare spending, and this scale of spending threatens the sustainability of the Medicare program. Furthermore, our nation’s older adults aren’t getting high quality coverage and care for all this spending.

[@g0989]

58:35 I don't see how making Medicare Advantage the default enrollment could possibly be implemented. For example, in many geographic areas, there are dozens of Advantage plans available, PPOs, HMOs, and PFFS plans, from a variety of insurance carriers, each with their own network. Would the government just pick one at random? What if the enrollee's providers don't contract with the default plan, but they do with some of the other plans? What about someone living in a rural county with no Advantage plans available? What then? I just see this as someone's pipe dream, with no thought being put into how it could actually be made to work.