NRLN President’s Forum
By Bill Kadereit
An analysis in the JAMA (Journal of the American Medical Association) Internal Medicine on June 10 concluded: “We think the time has come to declare MA [Medicare Advantage] a failed experiment and abolish it. That would allow redeploying the $88 billion taxpayers will overpay MA this year to upgrade benefits for all Medicare beneficiaries.”
The conclusion was based on the high cost of MA compared to traditional Medicare. For example:
Medicare Payment Advisory Commission (MedPAC), the nonpartisan agency reporting to Congress, recently estimated that MA overpayments added $82 billion to taxpayers’ costs for Medicare in 2023 and $612 billion between 2007 and 2024. Two insurer strategies drive MA overpayments: diagnosis upcoding and avoiding enrollees who are ill and do not contribute to profits.
Although MA insurers must accept all applicants in counties where they offer a plan, they are also free to withdraw from counties where they are accumulating unprofitable enrollees.
Only 2% of Fee-for-Service (FFS) Medicare expenditures go for overhead. But MA insurers incur extra expenses for television advertisements, health care network management, benefit design, executive salaries, health care utilization review, prior authorization, and shareholder profits, driving their overhead up to 14%.
This is according to a report from Milliman, an international actuarial and consulting firm, on MA financial results for 2022. Milliman estimates applied to subsequent years’ payments, MA overhead for 2007 to 2024 totals $592 billion—equivalent to 97% of taxpayers’ $612 billion overpayments to them during that period.
The authors closed their analysis stating, “A smarter, thriftier way to expand benefits and lower out-of-pocket costs is possible for all Medicare beneficiaries, but first, we must eliminate MA and double down on traditional Medicare, covering all enrollees in an expanded and improved Medicare program. That would be a good deal for patients and taxpayers.”
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NRLN Guarding Against Surprises to Social Security and Medicare With the convening of the new 119th Congress last week the NRLN has it eyes on the House and Senate. And after the Presidential inauguration on January 20, we will be watching the administration for anything that could negatively impact older Americans. There was good news on January 7 when House…
As we age, planning for long-term care becomes a priority, especially as we consider how best to support the needs of older adults. The National Retiree Legislative Network (NRLN) recognizes the importance of accessible, reliable resources for retirees and their families, and has compiled an extensive guide to help navigate the complexities of long-term care options. This resource provides invaluable…
During the Medicare Enrollment Period which is open until December 7 have your guard up against scammers who want to obtain your Medicare and Social Security information. Scammers pretend to be from Medicare or a healthcare insurance company. Here are tips to prevent you from being a scam victim. If you receive a call from someone claiming to represent Medicare,…
How to Purchase Medicare Advantage Insurance
Social Security Announces 2.5% Benefit Increase for 2025
Social Security benefits and Supplemental Security Income (SSI) payments for more than 72.5 million Americans will increase 2.5% in 2025, the Social Security Administration announced on Friday, October 10. On average, Social Security retirement benefits will increase by about $50 per month starting in January. Over the last decade the Cost-of-Living Adjustment (COLA) increase has averaged about 2.6 percent. The…
Do You Know Whether Your Medicare Advantage Plan Will Continue in 2025?

- National Retiree Legislative Network
Undoubtedly there are thousands of NRLN members with Medicare Advantage (MA) plans. Four MA insurance companies who provide MA plans have announced they will drop over 1 million enrollees across the nation in 2025.
Humana has told investors that the company expects to lose about 560,000, about 10% of its MA enrollees next year after it exits 13 unprofitable markets and trims its plan options. CVS Health Aetna will force 420,000 members to find other coverage. Centene – Wellcare announced in August it will be ending plans which will impact roughly 37,000 enrollees. Up to 5,395 Cigna beneficiaries will have to find new plans. UnitedHealthcare has not announced whether it will drop MA enrollees.
There have been news reports that MA insurers will be adding or raising premiums and increasing the out-of-pocket amounts due to higher expenses and lower profits as MA plan enrollees get older and have more healthcare costs. If your plan is discontinued, it is an opportunity to give thought to whether you want to continue in an MA plan (Part C) or enroll in original Medicare (Parts A and B) and a Medigap plan.
If you have not heard from your MA insurer about the status of your plan for next year, you should immediately contact your MA plan provider or your insurance agent to learn whether your plan will be continued.
If your plan is going to end on December 31, 2024, you should be sure to obtain a letter or email from your MA plan provider that states, as federal law requires, that you have a Guaranteed Issue Right (GIR) to get another MA plan or go into Original Medicare.
With a GIR you can acquire an MA plan or enroll in an Original Medicare, and if you choose, buy a supplement policy (Medigap) to cover the 20% that Medicare does not pay. The GIR provides you 63 days after your current MA Plan coverage ends to obtain other healthcare coverage. The upcoming Medicare Open Enrollment period October 15 – December 7 will be available to enroll in a new plan.
During the 63-day window, you cannot be denied for an MA plan or Original Medicare with a Medigap plan due to a pre-existing medical condition or face underwriting due to your medical history.
If your MA plan ends and you do not take action to acquire a different MA plan or enroll in Original Medicare you will be automatically enrolled in Original Medicare, but without a Medigap plan. Your MA plan that may be ending could have included Medicare Part D for prescription drugs. If so, it would be wise to shop for and purchase a Medicare Part D plan or an MA plan that includes Part D coverage.
Keep any letters, notices, or emails from your MA plan stating that your plan will be discontinued. You may need the information to prove your coverage ended to gain a GIR.
The NRLN website at www.nrln.org has video to assist anyone who wants to shop for a Medigap plan on www.medicare.gov. Another video will be created and posted in early October on how to search for Medicare Advantage plans on www.medicare.gov.
The NRLN wants to help you get the healthcare coverage that is right for you at the best price. Ask your friends to sign up at https://nrln.org//2021/01/email-sign-up/ to receive NRLN emails. We will keep you informed on this MA issue and other issues important to retirees.
Bill Kadereit, President
National Retiree Legislative Network
GET READY for Medicare Open Enrollment
Start Getting Ready for Annual Medicare Enrollment
The NRLN will be posting a series of short videos and brief articles to help our members prepare for the annual Medicare enrollment October 15 – December 7, 2024.
The first video is below. Click on the play icon to learn about three steps you can start taking now to be better prepared for the enrollment period.
- Make a list of your healthcare costs.
- Note changes to your health.
- Make a pros and cons list of traditional Medicare and Medicare Advantage plans.
Send an email to contact@nrln.org to tell us what other information would be useful to you to prepare for enrollment and during enrollment.
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MEDICARE AND YOU HANDBOOK 2025
In the News
The articles and opinion pieces below are for information and are not necessarily a reflection of the NRLN’s position on issues.
The NRLN is nonpartisan and its positions on retirement issues are presented in its Legislative Agenda and white papers that can be accessed from under the Legislative Agenda tab on the website main menu.
Medicare Advantage changes force Vt. seniors to find new plans WCAX TV News – Oct. 31, 2024
This retirement expert saved her mom $1,200 on Medicare drugs — and she’s got advice for you, too MarketWatch – Oct. 31, 2024
What you need to know about Medicare Part D’s $2,000 out-of-pocket prescription drug cap USA TODAY – Oct. 31, 2024
New OIG Report Calls for Stricter Oversight in Medicare Advantage Payments Retirement Daily on The Street – Oct. 29, 2024
Many Medicare patients can’t afford a single hospital visit Consumer Affairs – Oct. 29, 2024
Medicare Advantage In-Home Health Assessments Continue To Raise Questions Home Health Care News – Oct. 28, 2024
How to use Medicare star ratings wisely during open enrollment Fortune – Oct. 28, 2024
Blue Cross Blue Shield of Texas Medicare and Medicaid are leaving MD Anderson. Here’s what that means Houston Chronicle – Oct. 25, 2024
HCA sees ‘way too many denials,’ especially for Medicare Advantage, CEO says Hospital CFO Report – Oct. 25, 2024
Does It Really Make Sense to Work While on Social Security? It Depends on These 2 Factors The Motley Fool – Oct. 25, 2024
Medicare Advantage plans received billions from Medicare for home visits. The feds are skeptical Fierce Healthcare – Oct. 24, 2024
Analysis: MA plans classify 3 to 4 times as many hospital stays as observation visits compared with traditional Medicare American Hospital Association – Oct. 24, 2024
Allina may exit Humana’s Medicare Advantage network in 2025, affecting 18,000 Minnesotans The Minnesota Star Tribune – Oct. 23, 2024
Medicare drug plans are getting better next year Los Angeles Times – Oct. 23, 2024
Considering Medicare Advantage during open enrollment? Watch out for the ‘Hotel California’ trap. MarketWatch – Oct. 22, 2024
Supplemental Medicare Benefits Still Leave Care Out of Reach for Many Retirement Daily on The Street – Oct. 22, 2024
Organizations unite to promote 2025 Medicare drug changes The Hill Newspaper – Oct. 22, 2024
Insurer Centene sues US over downgrade in Medicare ‘star’ rating Reuters – Oct. 22, 2024
Work Longer or Live Poorer: What Raising Social Security Retirement Age Would Mean Investopedia – Oct. 22, 2024
Walmart offering same-day prescription drug delivery Axios – Oct. 22, 2024
Medicare drug plans are getting better next year. Some will also cost more. CBS News – Oct. 21, 2024
Humana stock higher on key merger report amid Medicare Advantage hit TheStreet – Oct. 21, 2024
People with certain disabilities are eligible for Medicare under age 65. Here’s who qualifies Fortune – Oct. 21, 2024
Most independent pharmacies may not carry negotiated Medicare Part D drugs Healthcare Finance – Oct. 21, 2024
CVS Health stock crushed as Medicare Advantage hit triggers big changes The Street – Oct. 18, 2024
Senate report hits top 3 Medicare Advantage insurers over ‘refusal’ of of skilled nursing, other coverage McKnights Long Term Care News – Oct. 17, 2024
Insulin Coverage: What Medicare Beneficiaries Need To Know For 2025 Forbes – Oct. 17, 2024
Insurers cut Medicare Advantage plans in Oregon, leaving thousands to find new coverage OregonLive.com – Oct. 17, 2024
Opinion: Who’s Really Cutting Medicare? The Wall Street Journal – Oct. 16
Are you ready for all the changes coming to Medicare? WKBN – Oct. 16
When You Need to Pay Taxes on Social Security U.S. News – Oct. 16
Health secretary touts improvements to Medicare at UNLV town hall Las Vegas Sun – Oct. 15, 2024
Medicare Plans Are Making Big Changes for 2025. Here’s How to Navigate Them. The Wall Street Journal – Oct. 15, 2024
Retirees can shop for health-care coverage during Medicare open enrollment. It’s a great time to review costs, experts say CNBC – Oct. 15, 2024
5 Big Changes to Medicare Part D for 2025 (And What to Do About Them) NerdWallet – Oct. 15, 2024
How Trump and Harris Aim to Address Your Health Care NerdWallet – Oct. 15, 2024
Changes in store for Medicare Advantage as open enrollment starts CNN – Oct. 14, 2024
Medicare Open Enrollment for 2025: Everything You Need to Know Newsweek – Oct. 14, 2024
The 2025 Social Security COLA Is Out. Here Are More Numbers You Need to Know. Think Advisor – Oct. 14, 2024
Patients Are Relying on Lyft, Uber To Travel Far Distances to Medical Care KFF Health News – Oct. 14, 2024
Across Party Lines, Americans Are United in Their Support for Social Security and Pensions National Institute on Retirement Security – Oct. 8, 2024
Medicare Advantage star ratings 2025—Who are the winners and losers? Fierce Healthcare – Oct. 11, 2024
You Could Pay Only $2 for These Drugs Soon Under Medicare Kiplinger – Oct. 11, 2024
Social Security announces 2.5% COLA increase for 2025. Here’s what to know Washington Examiner – Oct. 10, 2024
Medicare Advantage star ratings dip slightly once again in 2025 Fierce Healthcare – Oct. 10, 2024
US health agency releases 2025 quality ratings for Medicare plans Reuters – Oct. 10, 2024
What Hurricane Milton Means for Social Security Payments Newsweek – Oct. 9, 2024
CMS Increases Scrutiny on Nursing Home Ownership by Seeking Mandatory Medicare Revalidation Skilled Nursing News – Oct. 9, 2024
One Way to Spot Early Cognitive Decline? Medicare Wellness Visits Medpage Today – Oct. 9, 2024
Got a notice of change from your Medicare plan? Here are 3 things to pay attention to USA TODAY – Oct. 8, 2024
Problems With The Medicare Prescription Payment Plan On Medicare.gov? Forbes – Oct. 8, 2024
More Medicare Advantage Beneficiaries Are Filing Appeals for Denied Services or Treatments The Commonwealth Fund – Oct. 8, 2024
Company Behind Major Social Security Number Leak Files for Bankruptcy PCMag – Oct. 8, 2024
How can I protect my social security number from hackers and scams? News Nation – Oct. 8, 2024
Medicare shake-up sends Humana stock down 23% in a week for its worst drop since 2009 Market Insider – Oct. 4, 2024
Mayo Clinic tells hundreds of Medicare Advantage patients to obtain new insurance to keep getting care The Minneapolis Star Tribune – Oct. 4 2024
Federal government may be paying twice for care of veterans enrolled in Medicare Advantage plans Brown University – Oct. 4, 2024
Social Security chief Martin O’Malley clears up myths, bemoans staffing levels and more USA TODAY NETWORK – Oct. 4, 2024
6 Critical Changes You Can’t Afford to Miss in Your New Medicare Advantage Letter Investopedia – Oct. 3, 2024
CMS faces another star ratings lawsuit, this time from UnitedHealthcare Fierce Healthcare – Oct.3, 2024
Taking care of the caregivers. New Medicare pilot project rethinks paying for dementia care. New Hampshire Bulletin – Oct.3, 2024
UnitedHealthcare Adds Deductibles to Medicare Part D for 2025 Managed Health Care – Oct. 3, 2024
2025 Medicare Part D Drug Plan Premiums: Under Control But In Flux Forbes – Oct. 2, 2024
Medicare Advantage giant Humana reels after ratings cut The Washington Post – Oct. 2, 2024
Medicare Downgrades Humana Plan Over Quality. Time to Shop Around?Barron’s – Oct. 2, 2024
US Medicare issues updated rules for second round of drug negotiations Reuters – Oct. 2, 2024
Don’t Ignore the Letter You Just Got From Your Medicare Part D Provider Investopedia – Oct. 2, 2024
Health insurers unveil Medicare Advantage plans for 2025 Reuters – Oct. 1, 2024
For 2025, Insurers Pull Back Slightly On Medicare Advantage Footprints Forbes – Oct. 1, 2024
UnitedHealthcare 2025 Medicare Advantage Plans Deliver Choice, Stability Press Release – Oct. 1, 2024
Aetna Updates MA and Drug Programs for Medicare in 2025 Managed Healthcare – Oct. 1. 2024
With Medicare’s annual enrollment period 2 weeks away, here’s what major payers will have on offer Fierce Healthcare – Oct. 1, 2024
Are Online Discount Websites Helping Medicare Beneficiaries? The Commonwealth Fund – Oct. 1, 2024
3 key changes will help poor qualify for more money through a Social Security program USA TODAY – Oct. 1, 2024