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2/18/2025
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Sen. Ujifusa and Rep. Stewart bills aim to protect Rhode Islanders from Medicare Advantage’s disadvantages
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STATE HOUSE – Sen. Linda Ujifusa and Rep. Jennifer Stewart are sponsoring two pieces of legislation to protect Rhode Islanders from the disadvantages of Medicare Advantage insurance plans.
The two legislators are sponsoring a resolution calling on the state’s federal delegation to address the many concerns about Medicare Advantage at the federal level, as well as a bill to allow Medicare Advantage enrollees to purchase, at any time, a “Medigap” plan that caps their out-of-pocket expenses and prohibits the use of pre-existing conditions to deny coverage or impose excessive premiums.
“Original Medicare was not perfect,” said Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol). “But instead of building up the existing Medicare program that had a relatively small administrative cost and let patients see any doctor they wanted without prior authorization, Congress decided to allow private corporate insurers to step in.”
Now, more than half of those eligible for traditional Medicare have Medicare Advantage plans because they offer cheaper up-front costs and are aggressively marketed. The resolution (2025-S 0056, 2025-H 5434) asks the federal delegation to push to address the remaining problems with Medicare Advantage that prevent seniors from getting the affordable care they want and deserve.
“People do not realize that Medicare Advantage plans can have significant disadvantages,” said Representative Stewart (D-Dist. 59, Pawtucket). “These include severe limits on which doctors and hospitals enrollees can use, prior authorization requirements that block enrollees from getting care their doctors ordered and higher out-of-pocket costs when they become seriously ill. In addition, Medicare Advantage marketing simply does not provide enough information about how limited and limiting their coverage is, nor how difficult it is to switch plans. Surely, the public deserves more transparency.”
The estimated amount overpaid to Medicare Advantage is as much as $140 billion annually — more than the amount needed to address important traditional Medicare gaps. In addition, Medicare Advantage plans have been found to use prior authorization to deny medically necessary care.
When enrollees leave their Medicare Advantage plan to return to traditional Medicare, many would like to purchase a Medigap plan that limits out-of-pocket costs, but such coverage is unaffordable because it considers pre-existing conditions. The bill (2025-S 0267, 2025-H 5499) introduced by Representative Stewart and Senator Ujifusa is intended to remove this barrier to leaving Medicare Advantage.
“Seniors expect Medicare to be there for them in their golden years, but so-called ‘Advantage’ plans have a history of putting profits ahead of patients,” said Dr. Ed Weisbart, national board secretary of Physicians for a National Health Program. “These plans are run by corporations like UnitedHealthcare, which have been delaying and denying care for seniors while draining resources from Medicare to pad the bottom line. We need Congress to take urgent action to end this profiteering and improve traditional Medicare.”
For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903
(401) 222-1923
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