Millennials can save Medicare

We are entering the final week of Medicare enrollment for 2023. As a 30-year-old public health researcher who receives private insurance through her job, one might question the relevance of Medicare in my life. Hear me out.

As our parents become Medicare-eligible in the coming years, they will be faced with a choice: choose a traditional Medicare plan, paired with a supplemental plan to cover what Medicare won’t cover — or choose a Medicare Advantage (MA) plan. Medicare Advantage plans are typically low-premium plans that claim to cover all services that traditional Medicare covers and then some.

However, the devil is in the details with MA plans, and the details can mean life or death, retirement or bankruptcy. Unlike traditional Medicare plans that are overseen by the government, MA plans are administered by a private insurer that receives a flat rate per enrollee from the government. To control their costs and maximize their profits for investors, MA providers intentionally delay care through medical management practices (i.e. “prior authorizations”) and restrict patients to narrow physician networks — issues that traditional Medicare enrollees typically do not experience. All told, if your parent gets really sick, their Medicare Advantage plan likely won’t have their back.

A study this year by the U.S. Department of Health and Human Services’ inspector general found that MA plans “sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules.”

In 2021, my dad turned 65 and was faced with his Medicare choice. At the time, he was just starting to deal with a blood disorder that would later turn into a diagnosis with MDS — a complex blood cancer. I asked him whether he was planning to go the traditional route or opt for a Medicare Advantage plan, to which he responded, “You mean Medicare Disadvantage?”

Despite the allure of a lower-cost plan, he went traditional. Months later, he was lying on a bed at Memorial Sloan Kettering Cancer Center that was covered by his insurance. Memorial Sloan Kettering does not accept most Medicare Advantage plans.

His foresight in making that decision was invaluable. Indeed, a recent study in the Journal of Clinical Oncology reported that MA recipients were less likely to receive cancer care from a high-volume cancer provider and had higher 30-day mortality rates when compared to traditional Medicare enrollees.

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Unlike my father, many seniors are enrolling in Medicare Advantage plans each year. In 2007, just 19% of Medicare beneficiaries were enrolled in an MA plan; today, that number has grown to nearly half of Medicare-eligible seniors, an estimated 28 million people.

The inadequacies of traditional Medicare are at least partly to blame for creating a market for MA. For one thing, traditional plans fail to cover hearing, vision and dental, and leave enrollees with a 20% coinsurance fee for physician care, necessitating additional coverage through a supplemental plan. Moreover, rising Medicare premiums make Medicare Advantage plans that much more enticing. These issues require urgent legislative action to expand Medicare coverage and control out-of-pocket costs for seniors.

Rising enrollment in MA plans may come as no surprise to those over the age of 65, who have experienced the pushy letters, phone calls, and TV and online advertisements that target their demographic. Aggressive and often deceptive advertising for MA plans promise superior coverage without reliably disclosing the downsides.

Indeed, in 2022 the federal Centers for Medicare and Medicaid Services has begun to rein in deceptive TV advertising by MA insurers. However, we are far from controlling the beast. A recent New York Times exposé reported that overbilling from MA insurers accounted for somewhere between $12 billion and $25 billion in taxpayer spending during the 2020 fiscal year. This suggests that MA engenders both a personal cost to families as well as a fiscal cost to the American taxpayer.

Watching your parents age is both a blessing and a poignant reality. The truth is that they will likely face some health challenges at one point or another — as will we. When that time comes, it will be difficult no matter what. No one should have to fight with their insurance for life-saving medical treatments, or face losing whatever savings they’ve managed to accumulate for their retirement.

In the 2010s, a series of accusatory (and often misguided) opinion pieces blamed millennials for killing a great many industries, including luxury goods, department stores, cable TV, cruises, beer and canned tuna. My personal favorite title read, “ ’Promiscuous’ Millennials Are Killing McDonald’s.” Given that we already shoulder a reputation for industry murder, I propose we add just one more industry to our hit list: Medicare Advantage. For the sake of our parents and eventually, for ourselves.

D’Angelo is a doctoral student at the CUNY School of Public Health & Health Policy.