In 2017, Gary Bent was notified that his healthcare benefits were changing. Mr. Bent, a retired professor who taught at the University of Connecticut, received his Medicare coverage through his former employer. Prior to 2017, Gary was covered by traditional Medicare and a supplemental MediGap policy (which covers the 20% of medical costs not paid by traditional Medicare). However, in 2017 the state of Connecticut and Bent’s union renegotiated healthcare benefits for retired employees and entered into a Medicare Advantage contract.

Medicare Advantage is a for-profit, privately administered healthcare plan which covers people over the age of 65, or who have qualifying disabilities. Unlike traditional Medicare—the widely popular, government-run healthcare program that has covered America’s seniors for nearly 60 years—Medicare Advantage is rife with complaints of delays and denials of care, restricted provider networks, and the usual shortcomings of a for-profit healthcare system.

Years later, in June of 2022, Gary Bent had a recurrence of melanoma in the form of a bleeding lesion in his brain. Following a brain surgery, his neurosurgeon recommended he stay at a specialty hospital that could provide intensive care during his recovery. Despite being accepted as a patient, his Medicare Advantage plan said he had to go to a different facility, which his daughter, Megan Bent, described as “substandard.”

While he was in the rehab facility, Gary’s Medicare Advantage provider attempted to discharge him three times; Megan and her mother, Gloria Bent, filed appeals each time, and were twice successful. However, after losing the third appeal, Gary was discharged from the facility. Once he got home, he had a fever and was experiencing neck pain; he had been discharged from the facility while infected with bacterial meningitis.

After being readmitted for another three weeks, he was again discharged from the hospital and remained at home under the care of Megan and Gloria until he passed away shortly after. Following Gary’s death, Megan and her mother learned that Gary’s care was denied by an artificial intelligence program used by his Medicare Advantage provider.

The Bent family’s story is one shared by many families throughout the country, and despite increased criticism of Medicare Advantage in recent years, a growing number of unions have agreed to—or been forced into—moving their retired members out of traditional Medicare with supplemental MediGap coverage and on to these privatized plans.

To address this issue, the Labor Campaign for Single Payer recently hosted a webinar titled “Medicare Advantage and the Privatization of Healthcare: What Unions and Workers Need to Know,” which featured remarks from AFA-CWA president Sara Nelson, Sen. Elizabeth Warren (D-Mass.), and Rep. Pramila Jayapal (D-Wash.). The webinar also included informative and important presentations from Rose Roach, national coordinator for the Labor Campaign for Single Payer and Dr. Belinda McIntosh, board member for Physicians for a National Health Program, as well as testimony from Megan Bent and another Connecticut retiree, James Russell, both of whom are activists with the health justice advocacy organization Be A Hero.

Rose Roach opened her presentation by stating that the organization “never want(ed) to shame a union or their workers.” In truth, negotiators at the bargaining table are in a difficult position when it comes to negotiating retiree health benefits. While traditional Medicare rarely subjects patients to prior authorizations and allows them to see virtually any provider in the country, the program alone only covers 80% of healthcare costs. Therefore, unions must negotiate the purchase of a supplemental (MediGap) policy in order to cover the other 20%, with the combined premiums costing hundreds of dollars a month.

Medicare Advantage plans, on the other hand, often have low- or zero-dollar premiums and include coverage for dental, vision, hearing, and prescriptions (though the value of these additional benefits is often much less than beneficiaries were led to believe). However, patients in Medicare Advantage regularly experience claim denials and are often restricted to seeing a narrow set of in-network providers to get care. Insurance companies seek to maximize their profits by minimizing the amount of care their beneficiaries receive. The long-term costs of having to pay out of pocket for expensive treatments that are often not covered under Medicare Advantage plans can leave retirees and their families under mountains of medical debt.

Union negotiators may embrace Medicare Advantage because they are not fully aware of the long-term costs to their retirees, and because it looks like an opportunity to save money on retiree healthcare, which increases their leverage to bargain for better wages and benefits for in-service workers.

Despite increased public attention to the shortcomings of Medicare Advantage plans, many negotiators do not have the full picture of what it means to enter into a Medicare Advantage contract, and so the Labor Campaign for Single Payer developed a White Paper that highlights many of the important differences between the two options and includes a list of questions for negotiators to ask at the bargaining table, which they hope will result in more informed negotiations and fewer retired union workers ending up on Medicare Advantage.

In her remarks, Sen. Warren asserted that the name “Medicare Advantage” is misleading, arguing that the program “isn’t part of Medicare at all, and certainly not an advantage.”

Congresswoman Jayapal, the lead sponsor of the Medicare for All Act in the U.S. House, urged the attendees to make this issue a top priority in the coming years, saying “we can’t end up with Medicare Advantage for All, we need Medicare for All, and we need your organizing, your mobilizing, and your collective power to fight back against the giant........

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