Woonsocket Radio News Room

Sen. Ujifusa and Rep. Stewart introduce resolution to protect patients from ‘Medicare Advantage’ disadvantages

STATE HOUSE – Sen. Linda Ujifusa and Rep. Jennifer Stewart have introduced a resolution (2024-S 2402, 2024-H 7887) calling on the state’s federal delegation to address the growing concerns surrounding Medicare Advantage plans.

Established by the 1965 Social Security Amendments Act, Medicare provides health insurance coverage for individuals 65 and older and younger people with certain disabilities such as end stage renal disease. Original or “traditional” Medicare consists of Part A (hospital insurance) and Part B (medical insurance). 

Unfortunately, traditional Medicare lacked important coverage such as dental, vision, hearing and prescription drug coverage, as well as limits on copays and deductibles.  Instead of expanding original Medicare, Congress allowed private insurance companies to sell Medicare patients so-called supplemental, “Medigap” and “Medicare Advantage” insurance plans to fill in gaps, cover out-of-pocket costs, and even completely replace traditional Medicare. 

             “Most seniors who sign up for Medicare Advantage do not realize that private insurance companies now ‘manage’ their health care,” said Senator Ujifusa, (D-Dist. 11, Portsmouth, Bristol), “and these private companies can severely limit which doctors and hospitals they can use, prevent or delay them from getting medically necessary care, and often require more out-of-pocket costs when they become seriously ill, such as with cancer.”

Said Representative Stewart (D-Dist. 59, Pawtucket), “It is important to start educating the public about the disadvantages of so-called “Medicare Advantage” plans, because their aggressive marketing tactics do not disclose sufficient information.” 

Senator Ujifusa added that Medicare Advantage was supposed to save money and provide good health care, but studies have shown that neither of these goals have been met. The estimated amount overpaid to Medicare Advantage companies is as much as $140 billion annually — more than the amount needed to address important traditional Medicare gaps. In addition, Medicare Advantage plans have been found to use prior authorization to deny medically necessary care.

More than half of those eligible for traditional Medicare now have Medicare Advantage plans. 

“States cannot regulate Medicare Advantage plans,” said Senator Ujifusa. “That’s why it’s crucial to pass this resolution urging our federal legislators and agencies to act now.”