Arundhati Parmar , 2025-04-21 16:34:00
Straight talk is what everyone wants but rarely gets.
At the Medicarians conference held earlier this month in Las Vegas, I had the opportunity to engage Sachin Jain, CEO of SCAN Health Plan, in a fireside health chat to talk about the current state of Medicare. While he extolled the benefits of Medicare Advantage, he did not shy away from tough questions about the program and even agreed that the program needs changes.
SCAN is a nonprofit Medicare Advantage health plan with annual revenue of $5.5 billion and a member base of 301,000 seniors. Watch the full video below:
I am the first one to call my baby ugly (video timestamp 22:01)
Medicare Advantage was conceived as a way to rein in Medicare costs and to offer seniors more choice. But the program, while exploding in popularity – more than 54% of the eligible Medicare population is now enrolled in an MA plan, has not fulfilled its original mission of reducing the federal government’s costs.
The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, projected that in 2025, the federal government would spend approximately $84 billion more for MA enrollees than if those beneficiaries were enrolled in traditional Medicare. This represents a 20% increase in spending for MA plans. So just from this fact alone, the rai·son d’ê·tre or reason for being for MA seems faulty.
Separately, KFF( Kaiser Family Foundation) did an analysis in 2022 of 62 published studies on MA and Medicare since 2016 and concluded that there are very few major differences between the two programs. Neither MA nor traditional Medicare performed consistently better than the other across all quality measures.
When asked that question, Jain initially took a defensive tack and provided a financial reason to rebut the data and the question.
“I actually care about people’s affordability,” Jain retorted. “Nothing in there actually talks about people’s out-of-pocket affordability.”
As the plenary audience broke out in applause, he continued:
“At the end of the day, we have to think about the beneficiary and we have to think about what they can pay for and what they can afford.”
Earlier on in the interview, Jain described the affordability crisis in traditional Medicare. He described a married couple with an average income of about $54,000 becoming eligible for Medicare and they have to pay a part B premium of $184 per person per month, and then make them pay for Part D prescription drug coverage and supplemental benefits.
“So they’ve spent their entire life into paying Medicare taxes … and at the very end of their life, they have the privilege of paying $12,000 of their $54,000 income to pay for their health expenses,” he pointed out. “So it’s a fundamentally broken system that does not look anything like what Harry Truman originally imagined when he kind of imagined the Medicare program,” Jain explained.
It is in this context of a lack of affordability that MA should be compared with Medicare, he said. But at the same time, Jain did not gloss over real problems within MA — the cost and the “nefarious practices” that dupe seniors. Those have even led to calls for removing the term Medicare from Medicare Advantage.
“I think this program is expensive, and I think we need to fix aspects of it and there are bad actors who’ve run away with risk adjustment, and we need to fix that. The in-home assessment game has gotten out of control. We offer supplemental benefits that lots of people don’t use. So there’s a lot of deceptive practices in the industry, and a lot of people don’t necessarily actually know what they’re buying. So I’m the first person to call my baby ugly … but you know what the other baby is uglier.”
Later on he added, that MA “may cost more, but it may also be because it does more and that’s just something we don’t talk enough about, which is we should be doing more for older adults in this country.”
What Dr. Oz thinks of Medicare Advantage brokers (timestamp: 26:59)
In early April when the Medicarians conference was held, Mehmet Oz had not yet been confirmed by the Senate to lead the Centers for Medicare and Medicaid Services. What many conference attendees were not aware of was the fact that Oz was one of them — the New York Times reported in February that Oz is a licensed broker, able to sell MA plans in more than 20 states.
And the subject of MA was something that Oz himself raised toward the end of his Senate confirmation hearing. When Senator Ron Wyden (D-Oregon) asked Oz what he believes are “the biggest abuses are right now in the private insurance sector” Oz responded “Medicare Advantage sales.”
Oz went on to add that churn — insurance brokers selling different policies so that seniors are constantly switching from one MA plan to another — was something that should be looked into. He pointed out that if seniors did not have to select a plan every year, then perhaps some money could be saved from the middle which now the brokers pocket. He added there are probably too many MA agents, some good, some bad.
When asked to respond to that, Jain shot back that there are good brokers and bad brokers in the same way there are good journalists and bad journalists, good CEOs and bad CEOS. He did acknowledged that some bad brokers give the entire industry a bad name and then decided to issue a call to action to the hundreds of brokers in the audience.
“I’ve had this proposal out there for a while… it’s the idea that we should recast brokers
— because I think brokers just implies that all you’re doing is selling something — as community health workers. Because what you’re doing is really helping people navigate a really complicated healthcare system. And so I do think we need a cultural change in this industry.
