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Experts call for investigation into $86 billion in Medicare Advantage 'ghost benefits'
Center Square ^ | Jul 28, 2025 | Tom Joyce

Posted on 07/30/2025 12:43:56 PM PDT by george76

As Congress debates how to rein in federal spending, some experts say aspects of Medicare Advantage should be on the chopping block, starting with $86 billion a year in taxpayer-funded supplemental benefits that often go unused or unverified.

The federal government pays Medicare Advantage plans rebate dollars to cover extra services, including dental, vision, hearing, and over-the-counter drugs. However, a 2024 study published by JAMA Network Open found that only $3.9 billion of that money went toward dental, vision and hearing benefits.

Meanwhile, the industry spent an estimated $16 billion on $1,000 “Flex Cards” for new enrollees – prepaid cash cards often used for groceries, utility bills and even cable TV. Critics say the cards are mostly a marketing gimmick and don’t improve health outcomes.

“Amazingly, Medicare plans aren't required to tell regulators how much they spend on medical and prescription drug claims,” health policy expert Mark Merritt said in a statement. “This is a recipe for ghost benefits that look good on paper but can’t be accessed due to red tape and high out-of-pocket costs.”

Medicare requires insurers to project how they will spend their rebates, but not to report how they spend them. The Centers for Medicare & Medicaid Services (CMS) doesn’t verify whether the benefits are used or delivered.

The Medicare Payment Advisory Commission (MedPAC) flagged the issue in its June 2025 report to Congress.

It found a “fundamental lack of transparency” around how rebate dollars are spent and questioned whether these benefits improve outcomes or just boost insurance company profits.

Medicare Advantage plans also receive $40 billion this year in risk-adjusted payments and $12.7 billion in quality bonus payments. However, oversight is limited. A Wall Street Journal report found that $50 billion from 2018 to 2021 was paid based on diagnoses submitted by the plans themselves, not by doctors.

Plans are required to spend at least 85% of revenue on care and “quality improvements,” but CMS allows the $86 billion in supplemental rebates to count toward that number – even though most of it funds non-medical perks. That includes programs that restrict care, like prior authorization and AI-based claims denial systems.

Congress recently cut $9 billion through a rescissions measure – primarily foreign aid and public broadcasting money. The Medicare Advantage program alone gets nearly 10 times that in unverified perks.


TOPICS: Culture/Society; Front Page News; Government; News/Current Events; Politics/Elections
KEYWORDS: advantage; debt; deficit; medicare; medicareadvantage; medicaredisadvantage

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1 posted on 07/30/2025 12:43:56 PM PDT by george76
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To: george76
“Amazingly, Medicare plans aren't required to tell regulators how much they spend on medical and prescription drug claims,”

The system was designed, from the ground up, to be opaque.
2 posted on 07/30/2025 12:49:23 PM PDT by ComputerGuy
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To: george76

How about we move toward getting the US Government OUT of its unconstitutional adventure in providing a mandatory old-age pension and retirement plan?


3 posted on 07/30/2025 12:51:53 PM PDT by NorthMountain (... the right of the people to keep and bear arms shall not be infringed)
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To: george76

If we had a functioning press, they would be hailing the improvements.


4 posted on 07/30/2025 12:54:18 PM PDT by alternatives?
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To: george76

Lot’s of RAT campaigns are missing their cheese this electon cycle?


5 posted on 07/30/2025 12:54:53 PM PDT by IllumiNaughtyByNature (Polls are designed to sell more ads & polls only. If it's not a horse race the money dries up.)
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To: NorthMountain

But I don’t want to eat Alpo and have to go to a vet.


6 posted on 07/30/2025 1:01:17 PM PDT by crusty old prospector
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To: george76

Good. The Medicare Advantage program has always been a scam.


7 posted on 07/30/2025 1:01:19 PM PDT by Bob Wills is still the king
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To: george76

Medicare Advantage is unsustainable. It’s “too good to be true”.


8 posted on 07/30/2025 1:07:52 PM PDT by Fido969
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To: crusty old prospector
”But I don’t want to eat Alpo and have to go to a vet.”

Post Of The Week™.

9 posted on 07/30/2025 1:14:13 PM PDT by StAnDeliver (TrumpII)
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To: Bob Wills is still the king
Yeah, it's similar to "Obama Phones". Milking the government for "stuff".

10 posted on 07/30/2025 1:17:11 PM PDT by Governor Dinwiddie ( O give thanks unto the Lord, for He is gracious, and his mercy endures forever. — Psalm 106)
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To: george76
Meanwhile, the industry spent an estimated $16 billion on $1,000 “Flex Cards” for new enrollees – prepaid cash cards often used for groceries, utility bills and even cable TV. Critics say the cards are mostly a marketing gimmick and don’t improve health outcomes.

Medicare advantage is a rip off... big democrat program to help white liberal 'elites' running the scam.

11 posted on 07/30/2025 1:31:09 PM PDT by GOPJ (...taxpayers paid 18.75 million dollars per charging station..(under Biden) - Freeper SuperLuminal )
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To: george76

So now “they” want to get rid of Medicare Advantage Plans for things like dental, vision and hearing, which millions depend on and which Medicare does not cover.

Why not just imitate China and have no safety net at all? Think of the money that would be saved! Funeral parlors would be make fortunes as older Americans die off at even younger ages, even faster!

Pure genius!


12 posted on 07/30/2025 1:32:39 PM PDT by PIF (They came for me and mine ... now its your turn)
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To: george76

Or we could just get rid of the so-called experts and save a lot of trouble and money.


13 posted on 07/30/2025 1:33:54 PM PDT by PIF (They came for me and mine ... now its your turn)
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To: george76

Am guessing that “DOGE” didn’t make it to them, or they were blocked/redirected for some glorious reason.


14 posted on 07/30/2025 1:36:08 PM PDT by foundedonpurpose (Praise Hashem, for his restoration of all things! )
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To: crusty old prospector

But I don’t want to eat Alpo and have to go to a vet.


Dog food has improved a lot from the Alpo days, its almost human food now. But the vet situation has deteriorated and is almost as expensive as regular medical institutions, and the vets have funny accents to boot.


15 posted on 07/30/2025 1:37:07 PM PDT by PIF (They came for me and mine ... now its your turn)
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To: PIF

You need to reread the article.


16 posted on 07/30/2025 1:39:08 PM PDT by lastchance (Cognovit Dominus qui sunt eius.)
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To: NorthMountain
How about we move toward getting the US Government OUT of its unconstitutional adventure in providing a mandatory old-age pension and retirement plan?

Be my guest.

You can have your meeting to promote the plan in a phone booth.

17 posted on 07/30/2025 1:40:02 PM PDT by Jim Noble (Assez de mensonges et de phrases)
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To: george76

“”Medicare Advantage plans rebate dollars to cover extra services, including dental, vision, hearing, and over-the-counter drugs.””

It’s getting so we need a “glossary” to identify the meaning of words anymore. I don’t understand WHY “rebate” is used in this context. Those are the benefits of choosing a Medicare Advantage plan and not a “rebate” for anything if using its proper meaning - buy something, pay cash, get a rebate. Not the same at all.

Do we need dictionaries today for us old folks and ones for the younger set? Same with ANNEX when we associate that with an entirely different meaning than ADDING to documents...appendage? I understand words can be used differently than we have normally used them....just weird to come across so many changes...


18 posted on 07/30/2025 1:43:01 PM PDT by Thank You Rush
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To: george76

I got a credit card from Humana saying it’s a $100 monthly credit for over-the-counter drugs and I can accumulate that $100 over 12 months.

I went into Walmart and tried to buy a handful of items, only to have the machine state the card covered only half of them.

I still can’t find a list of what is allowed. You find out at checkout.


19 posted on 07/30/2025 1:52:30 PM PDT by Alas Babylon! (Repeal the Patriot Act; Abolish the DHS; reform FBI top to bottom!)
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To: george76

Dems and their propaganda media have convinced people “The Big Beautiful Bill cuts Medicare benefits from people we can’t survive without it so they can give budget money to their billionaire friends.”

So discrimination against Ghosts now and their money cut off just for being dead at the time?

Who you gonna call?


20 posted on 07/30/2025 1:54:12 PM PDT by frank ballenger (There's a battle outside and it's raging. It'll soon shake your windows and rattle your walls. )
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