Lawmakers push for Medicare Advantage reforms amid rising costs and enrollment confusion

The Senate Committee on Health & Human Services convened on April 3, 2025, to address critical issues surrounding Medicare Advantage and Medigap insurance plans in Rhode Island. The meeting highlighted significant concerns regarding the complexities and limitations of Medicare Advantage, particularly for seniors who often find themselves trapped in these private insurance programs.

One of the primary topics discussed was the introduction of a resolution aimed at urging federal representatives to regulate Medicare Advantage more strictly. A committee member emphasized that as beneficiaries' health declines, they face increasing financial burdens due to inadequate coverage. This situation has prompted the need for legislative action, as many seniors struggle to exit Medicare Advantage without sufficient options for alternative coverage.

The discussion revealed that over 50% of Medicare enrollees are now in Medicare Advantage plans, which have been criticized for overcharging taxpayers by an estimated $75 billion. The committee member pointed out that the federal government pays insurers a fixed amount per beneficiary, regardless of the actual services used. Additionally, the prevalence of care denials and the practice of "upcoding"—where insurers inflate patient conditions to receive higher reimbursements—were cited as major issues contributing to the program's profitability at the expense of patient care.

In response to these challenges, a proposed bill aims to establish a continuous enrollment period for Medigap plans, allowing beneficiaries to switch plans at any time. This change is intended to simplify the enrollment process, which is currently complicated by varying deadlines and requirements. The bill also seeks to expand coverage options beyond just Plan A, which is the least comprehensive and least utilized among Rhode Island's 40,000 Medigap enrollees.

The committee member urged that amendments be made to include additional Medigap plans, such as Plans C, F, and N, which have higher enrollment numbers and offer more comprehensive coverage. The meeting concluded with a call for further examination of the costs and limitations of existing plans, emphasizing the need for genuine choice and better protection for seniors navigating the complexities of Medicare insurance.

Overall, the discussions underscored the urgent need for reform in Medicare Advantage and Medigap insurance to ensure that Rhode Island's seniors have access to affordable and adequate healthcare coverage.