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How the Medicare Modernization Act Fueled Medicare Advantage Overpayments and Rebates

Mike Roth and Bill Kadereit discuss how the 2003 Medicare Modernization Act (MMA), following the failure of Medicare Choice, rebranded the program as Medicare Advantage and used risk adjustments and subsidies that raised MA payments above traditional fee-for-service, averaging about 14% higher from 2005–2009. They cite Inspector General reports in 2008–2009 criticizing excessive and improper payments, which they say were later recast as “rebates” under the 2010 Affordable Care Act, driving overpayments to roughly 16–17% and persisting through projected 2025 levels. They report MA enrollment growth (11.7M to 17.5M from 2010–2015; 34.4M and 55% market share by 2025) and rebate totals (about $89B in 2025, projected over $94B), arguing rebates subsidize extra benefits and insurer overhead/profit while traditional Medicare enrollees receive none, and urging policymakers to end rebates while protecting current beneficiaries.

Chapters
00:00 Podcast Introduction
00:57 MMA And Medicare Advantage
03:37 Risk Adjustment Explained
05:18 Overpayments And Rebates
07:18 Charts Show Rising Costs
09:31 Enrollment Growth And Market Share
10:39 Rebates Fund Extra Perks
12:43 Trillion Dollar Forecast
14:51 Fairness And Reform Ideas
15:59 Next Episode Preview

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History of Medicare (1965–2003), Part 1: Fee-for-Service, Managed Care, and the Road to Medicare Advantage

Mike Roth and Bill Kadareit introduce the first of three episodes on Medicare’s history from 1965 to 2003, aiming to highlight key turning points behind Medicare’s financial strain and possible solutions. Bill credits research support from the American Retiree Education Foundation and the National Retiree Legislative Network, asks listeners to donate, and explains demographic shifts: slower population growth, more beneficiaries living past 80, and a small share of older enrollees consuming most Medicare payments, with all baby boomers expected to be on Medicare by 2027. He argues Medicare and Social Security reserves are evaporating due to insufficient funding, rising average age, lack of productivity gains, and congressional interest in privatization. The episode contrasts Medicare’s traditional fee-for-service model and low overhead with insurers’ capitation/managed-care approach, then reviews policy milestones including the 1972 HMO amendment, TEFRA (1982), the Balanced Budget Act and Medicare Part C (1997), and sets up deeper discussion of changes after 2003.

00:00 Welcome and Topic
00:35 Series Roadmap
01:11 Support the Foundation
02:54 Demographics Driving Costs
04:51 Funding Risks and Politics
06:37 Medicare Fee for Service Basics
10:55 Why Insurers Want Control
11:34 1972 Shift to Managed Care
12:43 Capitation Explained Simply
14:15 1972 to 2003 Policy Timeline
19:48 Medicare Advantage Teaser
21:20 Wrap Up and Next Episode

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Medicare Prescription Drug Costs: Part D, Advantage Plan Squeezes, and Canada Importation

Mike Roth and Bill Kadereit discuss how retirees on Original Medicare buy standalone Part D plans from private insurers and how rising prescription costs have driven a 2026 “plan squeeze,” with 2.6 million Medicare Advantage plans discontinued and only 360 plans nationwide (down 29% from 2025). They cite premium shocks (e.g., Cigna rising from $37 to $91) and an IBM retiree example where a bundled plan was replaced by a separate $160 drug premium. They review Inflation Reduction Act provisions including a $2,100 Part D out-of-pocket cap, limited Medicare drug price negotiations (10 drugs, with 15 more for 2027), and a $35/month insulin cap. They note FDA enforcement discretion allowing personal importation from Canada up to 90 days, plus Florida’s 2024 authorization, and highlight pending bills such as S 641 and the Stop Stalling Act, while pointing to NRLN resources and upcoming episodes on enrollment and “guarantee issue” rights after plan terminations.

00:00 Prescription Costs Overview
01:05 Part D Plans and 2026 Squeeze
02:33 Premium Shock Stories
03:37 IRA Cap and Negotiations
04:30 Buying Drugs in Canada
06:44 Most Favored Nation Pricing
08:04 Rebates and Middlemen
09:35 Discount Cards and Import Rules
11:45 Drug Price Hikes and Bills
16:11 NLRN Resources and Action Alerts
17:08 Next Episode Enrollment Rights
20:24 Wrap Up and Where to Listen

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Guaranteed Issue Rights Denied: Protecting Seniors When Medicare Plans Are Non-Renewed or Terminated

Mike Roth interviews Bill Kadereit about Guaranteed Issue Rights (GIR) being denied when Medicare Advantage, Medigap, or Part D plans are non-renewed, terminated, or become unavailable after a move to another state. Kadereit explains key differences between non-renewal and termination and describes how insurers often “crosswalk” members into new plans without providing required GIR notices, limiting seniors’ ability to shop. He cites large-scale disruptions, including millions affected by 2025 terminations and non-renewals, and a Blue Cross Blue Shield of Michigan example, arguing seniors with chronic conditions can face rejection or higher costs without GIR protections. The discussion highlights weak enforcement, confusion between state and CMS responsibility, criminal/civil penalties that are not applied, and NRLN’s efforts through white papers, CMS meetings, and plans to involve attorneys general while urging seniors to report missing or inadequate notices.

00:00 Welcome and Topic

00:18 GIR Basics Explained

01:05 Nonrenewal vs Termination

01:43 Moving States Eligibility

03:06 Crosswalking Trap

04:35 Scale of the Problem

07:09 Join and Report Cancellations

09:20 Why Costs Are Rising

10:37 Penalties and No Enforcement

11:59 Who Enforces the Rules

13:26 SEP and Golden Ticket Rights

17:20 Company Plan Terminations

20:07 ACA Gap and Trial Rights

21:39 NRLN Actions and Next Steps

24:09 Wrap Up and Closing

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2026 Medicare Enrollment: Preparing for Medicare A, B, D, Medigap vs. Advantage, and Key Deadlines

Mike Roth discusses preparing for Medicare enrollment ahead of turning 65, explaining the seven-month Initial Enrollment Period and how waiting can delay coverage. He outlines Medicare Part B (physician/clinic care, preventive services, diagnostics, and certain clinic-administered drugs), its typical monthly premium and cost-sharing, and Medicare Part A (inpatient hospital, limited skilled nursing/rehab rules, and hospice), including key hospital cost amounts and the importance of qualifying inpatient status. The episode reviews Part D prescription coverage, late-enrollment penalties, and the drug cost cap. It compares Original Medicare plus Medigap versus Medicare Advantage (Part C), highlighting subsidies, extra perks, out-of-pocket maximums, network limits, travel and provider acceptance issues, and potential denials/delays for imaging and care. Resources include Medicare.gov Plan Finder, the “Medicare & You” handbook, Social Security, and SHIP counselors, plus key enrollment dates and cautions about switching and guaranteed-issue rights.

00:00 Medicare Enrollment Prep

01:24 Part B Basics and Costs

03:15 Part A Hospital Coverage

05:08 Part D Drug Plans

05:53 Medicare Advantage Explained

08:45 Advantage vs Original Medicare

11:21 Networks and Denials

13:38 CMS Wiser and AI

15:00 Extra Perks and Tradeoffs

17:16 Getting Help and Plan Finder

21:07 Enrollment Dates and Switching

24:17 Wrap Up and Contact Info

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Is Social Security at Risk? History, Solvency Timeline, and Policy Options

In episode two of “Creating a Better Life for Seniors,” Mike Roth and Bill Kadereit discuss whether Social Security is at risk, reviewing its origins in 1935, later additions including Medicare/Medicaid in 1965, and major changes such as the 1983 increase of full retirement age from 65 to 67. They link today’s funding challenge to slowing U.S. population growth, lower fertility/immigration, and a rising over-65 population, along with a declining worker-to-beneficiary ratio (from 5:1 in 1960 to 2.9:1 today). Citing trustee projections, they say the Old-Age and Survivors Trust can pay full benefits until late 2032, after which benefits may be reduced about 22% without action. They outline causes including boomers’ retirement, tax and benefit law changes in 2025, inequality under the $184,500 payroll cap, and discuss options: raising retirement age, increasing payroll taxes, eliminating/raising the wage cap, and means testing; they oppose raising the age and support eliminating the wage cap.

00:00 Podcast kickoff
00:36 Social Security origins
01:45 Funding can kicked
02:17 Population growth slowdown
03:39 Aging boomers pressure
05:00 Trust fund cliff 2032
07:07 Why insolvency happens
09:55 Congress options to fix
10:53 NRLN policy positions
13:12 Wrap up and next episode

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Protecting Your Future-2026 Retirement Revolution

NRLN & AREF: Protecting Retirees’ Pensions, Social Security, and Medicare in 2026

In this 2026 podcast episode, host Mike interviews Bill Kadereit, President of the National Retiree Legislative Network (NRLN) and Chairman of the American Retiree Education Foundation (AREF). Kadereit explains NRLN is a 501(c)(4), nonpartisan group representing over 2 million seniors from about 300 companies and public entities, funded primarily by member contributions, advocating to protect pensions, Social Security, Medicare, Medicaid, and lower prescription drug costs. He describes AREF as a separately financed 501(c)(3) that produces research and position papers on issues like pension risk transfers, Medicare guarantee rights, and protections in mergers and bankruptcies, funded mainly by individual donations. The discussion covers partisan gridlock, long-term underfunding risks tied to demographic trends, seniors’ voting power, NRLN’s Action Alert system via NRLN.org, and concerns that Medicare Advantage subsidies raise costs and support Medicare privatization.

00:00 Welcome and Guest Intro
00:34 What NRLN Does
01:18 Funding and AREF Overview
02:06 Research and Retiree Protections
02:52 Politics and Retiree Risks
04:08 Congress vs Retiree Reality
05:54 Senior Voting Power
06:50 How to Take Action
09:55 Long Term Underfunding Warning
10:47 Population Trends Explained
14:06 Medicare Costs and Privatization
17:04 Wrap Up and Next Episodes