The History and Challenges of Medicare Advantage

Medicare Advantage, introduced as a privatized alternative to traditional Medicare, has grown rapidly, now covering nearly half of all U.S. seniors. Despite its popularity, the program has faced significant challenges, including fraud, overbilling, and care denials. For years, advocates have raised concerns about these issues, but their efforts to push for reform have been largely stymied by the powerful insurance lobby. Recently, the Centers for Medicare & Medicaid Services (CMS) proposed reforms aimed at curbing “upcoding” and reducing care denials, but the insurance industry quickly mobilized to protect its interests. While these efforts led to a delay in the full implementation of the reforms, advocates see the outcome as a small but significant step forward. For the first time in years, there is a visible shift in the conversation around Medicare Advantage, suggesting that more aggressive reforms may be possible in the future. Advocates are now focused on building broader support to ensure that the program prioritizes patient care and accountability.