New Report Highlights Medicare Advantage Insurers’ Higher Administrative Spending

Dec 9, 2009

Today Energy and Commerce Committee Chairman Henry A. Waxman and Oversight and Investigations Subcommittee Chairman Bart Stupak released a new report that found that 34 Medicare Advantage insurers expend significant sums on profits, marketing, and other corporate expenses.   Last year, the insurers spent an average of $1,450 per beneficiary on profits, marketing, and other corporate expenses, nearly ten times as much as traditional Medicare spent on administrative expenses per beneficiary.

On average, Medicare Advantage insurers spent over 15% of premium revenue on profits, marketing, and other corporate expenses.  Two-thirds of the Medicare Advantage insurers surveyed by the Committee had a "medical loss ratio" - the percentage of premium revenues used to pay medical claims - below 85% during at least one of the four years examined.  In contrast, traditional Medicare spends 98% of its money on medical care.  If all Medicare Advantage plans had spent at least 85% of their premium dollars on medical care from 2005 to 2008, they would have spent an additional $3 billion on medical care for seniors.

"Medicare plays a critically important role in insuring that millions of Americans receive the health care they need," said Rep. Waxman.  "But as this report shows, Medicare Advantage insurers are squandering billions of dollars on overhead costs - in fact, they spend ten times the amount per beneficiary as traditional Medicare.  Our health care bill includes much needed reforms to the Medicare Advantage payment system.  There is no reason for Medicare to pay private insurers more than traditional Medicare pays in any community in the country.  That will insure that taxpayer dollars are spent wisely."

"Medicare Advantage was never intended to be a program for insurance companies to pad their corporate expense accounts," said Rep. Stupak.  "Seniors pay Medicare Advantage premiums with the expectation that the money will be used to provide critical medical care - not pay for marketing campaigns and executive bonuses.  The disparity between the percentage of premiums used to pay medical claims in traditional Medicare and Medicare Advantage is unacceptable; our seniors deserve better.  This report is just the latest example of private insurance companies exploiting the Medicare Advantage system for their own gain."

At the request of Chairman Waxman and Subcommittee Chairman Stupak, the majority Committee staff analyzed premium revenues, medical claim payments, marketing costs, profits, and other data from 34 major Medicare Advantage insurers.

The report found:

  • From 2005 through 2008, the average Medicare Advantage insurer spent over 15% of premium revenue on profits, marketing, and other corporate expenses. Two-thirds of the Medicare Advantage insurers surveyed by the Committee had a medical loss ratio below 85% during at least one of the four years examined. Six of the insurers had medical loss ratios below 75% in one or more years. In comparison, traditional Medicare spends less than 1.5% on administrative expenses and over 98% on health care. In the aggregate, the Medicare Advantage insurers spent $1,450 per beneficiary in 2008 on profits, marketing, and other corporate expenses, nearly ten times as much as traditional Medicare spent on administrative expenses per beneficiary.
  • Requiring all Medicare Advantage insurers to have a medical loss ratio of 85% would provide billions of dollars in additional medical services to seniors. The total amount spent on profits, marketing, and other expenses by Medicare Advantage insurers over the last four years was $27 billion. The House health care reform bill requires Medicare Advantage plans to spend at least 85% of their total premium revenues on medical claims. If this threshold had been in effect from 2005 through 2008, the Medicare Advantage insurers would have spent an additional $3 billion on their beneficiaries' medical care, enough to eliminate all copays for preventive care for all Medicare beneficiaries for ten years.
  • In 2007 and 2008, Medicare Advantage insurers with medical loss ratios lower than 85% paid their executives over $1.2 billion. In 2007, a company that had a medical loss ratio of 79% paid an executive over $35 million. The same company paid 16 more executives salaries and bonuses worth $1 million or more. Another company with a medical loss ratio of 79% paid more than $210 million in compensation to 260 executives.
  • Medicare Advantage insurers have spent millions on expensive retreats. In 2007, one company with a medical loss ratio of 83% spent $3.1 million for two events in Hawaii. In 2007, a company with a medical loss ratio of 84% spent $2.5 million on employees and agents at a retreat in San Jose del Cabo, Mexico and $1.4 million on an event in Rome, Italy. In 2008, a company with a medical loss ratio of 82% spent $1.5 million on a meeting in Edinburgh, Scotland and $1.8 million on a trip to Cancun, Mexico.

Note: In December 2009, Rep. Henry Waxman and Rep. Bart Stupak released a report that found that 34 Medicare Advantage insurers surveyed by the Committee spent an average of $1,450 per beneficiary on profits, marketing, and other corporate expenses, nearly ten times as much as traditional Medicare spent on administrative expenses per beneficiary.