The following article summarizes the original event which is listed below the summary.

When Will the Medicare Advantage Bubble Burst?

May 8, 2023, at 1pm

Recording spreads awareness to rein in the Medicare Advantage (MA) privatized system, and protect traditional Medicare funding.

1. Explains overpayments & profits of Medicare Advantage (MA) health plans, and the legally required return of some profits to enrollees.

2. Medicare Advantage (MA) enrollees have low premiums and broader benefits compared with the TM because the plans are overpaid, not because they are more efficient or altruistic. See slides # 8. Ranking of MA plan attributes, and see slide # 9. MA Coverage negatives including unexpected claim denials, high costs, and delayed payments.

3. See slides # 10, 11 & 12. On Claim Denial & Over Charge Options. This response process is applicable to any claim/medical billing surprises or denials.

4. Below is a supplement to the recording and PowerPoints:

Enrollees in TM (Traditional Medicare) can choose any providers — primary care doctors, specialists and hospitals. MA (Medicare Advantage plans) limit these choices.

Medicare sets payment rates, and the rules for health care providers. Studies suggest that MA prices paid by insurers were close to Medicare Fee–For-Service prices, and were similar in and out of network.  Most Health providers accept Medicare payments without additional charges to enrollees.

 In TM you don't need referrals to see any medical provider, and you don't have to worry about your doctor leaving a plan's network. TM rules do not interfere with medical decisions, and do not have financial incentives to deny services.

Medigap private insurance is only supplemental to traditional Medicare (TM). Medigap policies help cover some of TM out-of-pocket costs, such as deductibles, copayments, and coinsurance, and may pay charges over Medicare payments.  

MA plans can limit your choice of doctor, have financial incentives for doctors to deny services, and can deny, delay, or limit services (for example, discharging from a hospital or skilled nursing facility before your provider thinks you're ready to leave).

A report from MedPage Today on a hearing held in the US Senate on 05/17/23 describes a half-dozen examples of Medicare beneficiaries who were abused by their MA plan. Sen. Bumenthal (D-CT) is quoted saying Medicare beneficiaries who enroll in MA plans "face denials in the middle of major medical crises, forcing them and their loved ones to fight even as they are fighting for their lives. -----"It's fine, so long as you don't need it for the big stuff"; Congress Hearing Explores Medicare Advantage Routines That Deny, Delay Needed Care | MedPage Today

 I welcome your comments on your MN based TM with a supplement, and on your MA plan experience.

~  UMRA Financial & Legal Group, Andy Whitman, FLG facilitator, [email protected], 612-747-6015.


Kip Sullivan, JD, a prolific author and health policy advisor to the nonprofit organization Health Care for All Minnesota, and nationally.

Robert Hall, CFP, Carlson MBA (Ret.) an advisor and lecturer in Carlson School Personal Finance and Risk Management courses.

Andy Whitman, JD, PhD, Professor of Finance, The Carlson School, UMN.

Event recording
Click on , then    to view recording in full screen.




When will the Medicare Advantage bubble burst?

Mon, May 8 2023, 1pm

By Zoom

Join Zoom link, 1pm - 2:30 pm  (no need to register, just use this link)


                       Andy Whitman, PhD., UMN professor of insurance
                       Kip Sullivan, author and health policy advisor to Health Care for All Minnesota
                       Bob Hall, CFP (retired)

This workshop looks at a troubling issue, described in the March 22, 2023, article 

Biden Plan to Cut Billions in Medicare Fraud Ignites Lobbying Frenzy
By Reed Abelson and Margot Sanger-Katz

The Biden administration has proposed changes to how it would pay private Medicare Advantage plans.  “We need strong oversight of this program,” Dr. Meena Seshamani, the director of the Center for Medicare, said of Medicare Advantage. [See additional references below.]

Why the Medicare Advantage (MA) plans are so overpaid. Kip (20 minutes)

  • History of the privatization of Medicare
  • Favorable selection: Enrollees in Medicare Advantage are healthier; sicker enrollees are driven away.
  • But CMS/HCFA was never able to "risk adjust" premium payments to MA plans downward to match the lower cost of MA enrollees.
  • After 2006, "improved" risk adjustment introduced a new way for MA plans to profit: Upcoding

MA plan profits so large they had to return Billions in premium "over charges".  Andy (5 minutes)      

MA enrollees don't know what their coverage is until they need it! Andy (5 minutes) 

  • Claim denials not challenged
  • Fraud in challenged claim denials
  • Actions when claims are denied

Experience in Medicare Advantage - "To Good to Be True?"  Bob (5 Minutes)    '

UMN's Retiree Medicare Advantage choice?   Andy (5 minutes)

  • Dangers of relying on outside entities to explain employee choices
  • Medicare Advantage (MA) or Traditional Medicare
  • Long Term Care Insurance
  • Engaging a Financial Planner

Terminating MA plan overpayment is essential to protecting the Medicare trust funds. Kip (5 minutes)

  • Medicare trustees predict Medicare Part A will be in the red by 2028

Please send questions and comments that we can address to Andy Whitman [email protected]


Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds - The New York Times (nytimes.com)

Opinion | For seniors, Medicare Advantage plans come with big disadvantages - The Washington Post

Medicare Plan Commissions May Steer Beneficiaries to Wrong Coverage | MedPage Today

Did Your Health Plan Rip Off Medicare? | Kaiser Health News (khn.org)

Medicare Advantage Plans Fielded 35 Million Prior Auth Requests in 2021 | MedPage Today

How Insurers Exploited Medicare Advantage for Billions - The New York Times (nytimes.com)

Almanac | Mike Hatch versus Blue Cross | Season 2001 | Episode 6 | PBS

Upcoming Events

Event Date: October 2, 2023, at 9:30am

We will meet at the Mel-O-Glaze bakery on 28th and Minnehaha Parkway and walk to Minnehaha Falls and then back again.

Event Date: October 3, 2023, at 1pm

Some of the most valuable and rare maps in the world are held in UMN's own James Ford Bell Library, housed in Andersen Library  See https://www.lib.umn.edu/collections/special/bell .

Event Date: October 4, 2023, at 10am

The first meeting of UMRA’s Family History Interest Group for 2023–24 will feature a presentation by Marilyn DeLong about sharing family stories and learning surprising family connections. 

Event Date: October 4, 2023, at 10am

UMRA has a special opportunity to engage with the four newest members of the U of M Board of Regents on Wednesday, October 4, via Zoom. The purpose of the event is to share our perspectives as former University employees. 

Event Date: October 10, 2023, at 12:30pm

All UMRA members with an interest in photography are welcome to attend the meeting of the UMRA Photo Club on Tuesday, October 10. We welcome photographers of all abilities. Most of us are struggling amateurs. We laugh a lot and learn from sharing and talking about our pictures.

Event Date: October 16, 2023, at 9:30am

The walk along the Mississippi River in Minneapolis is always changing, with many attractions being added along both sides of the river and, now, the beautiful fall colors.

Event Date: October 19, 2023, at 11am

UMRA’s workshop on Open Enrollment for U of M retiree health plans for 2024 will include a briefing on the choice between Medicare Advantage plans and Medicare Supplement Insurance (Medigap) plans, by Jeff Snegosky of BCBS of Minnesota, followed by an overview of the U of M’s retiree health insurance plans, by Katie Kolodge from the Office of Human Resources.

Event Date: October 20, 2023, at 2pm

Mary Jane Towle will lead the discussion of The Dictionary of Lost Words by Pip Williams.

Event Date: October 24, 2023, at 11am

To help us understand the growing movement in the U.S. to ban books, especially children’s literature, and the critical role of libraries to protect intellectual freedom, UMRA will welcome U of M Librarian Lisa Von Drasek (pictured) and Rochester Public Librarian Kimberly Edson as the guest speakers for our October luncheon forum at Midland Hills. 

Event Date: October 27, 2023, at 2pm

The Fourth Friday Book Club will meet from 2 to 3:30 p.m. CDT on October 27 to discuss the life and narrative of Frederick Douglass.

Event Date: November 6, 2023, at 9:30am

Join us for a 5 mile moderately paced hike around Pleasant Lake located in the heart of North Oaks.  It takes us past some of James J. Hill’s original farm buildings as well as beautiful homes built along the lakeshore. The trail is wide, generally flat and consists of packed dirt and crushed rock. 

Event Date: November 6, 2023, at 9:40am

The documents noted for this event specify your managers and can minimize income taxes now, and estate taxes. 

Event Date: November 7, 2023, at 1pm

The material world we live in is shaped by design. While popular discussions of design typically focus on fashion and furniture, design is fundamental in art, architecture, and indeed nearly all aspects of the everyday world around us.  Goldstein Museum of Design curator Jean McElvain will demonstrate and discuss some of the fascinating and often unexpected holdings before we walk through the current gallery exhibit.

Event Date: November 27, 2023, at 9am - December 3, 2023, at 5pm

Get an insider's perspective on Santa Fe and Taos alongside local artists, exploring the Georgia O'Keeffe museum, enjoying traditional music and learning about native cultures. The deadline for reserving a space is June 2, 2023.

Event Date: December 4, 2023, at 9:30am

Please join us for an invigorating hike from The Monument located at the intersection of Mississippi RIver Blvd and Summit Avenue in St. Paul to Minnehaha Falls in Minneapolis and back.  This hike is on paved trails, approximately 5.5 miles in length, and will be at a pace suitable to the weather.

Event Date: December 13, 2023, at 11:30am

Topics include tax changes; tax reducing moves required now and tax management in 2024 & 2025.