There are changes afoot in how government agencies will oversee health care for retirees and older adults. President Donald Trump tapped physician and TV personality Dr. Mehmet Oz to lead the Centers for Medicare & Medicaid Services (CMS). Although there is still no firm date for his confirmation hearing, Dr. Oz has already proposed a vision for Medicare that would increase private-sector involvement.
Like his potential future boss — head of the Department of Health and Human Services Robert F. Kennedy Jr. — Oz is a controversial pick. The two men have been criticized for sometimes supporting unproven remedies rather than scientific evidence. For example, Oz has a history of promoting questionable supplements and unproven weight loss strategies, and prominent doctors have criticized Oz for his “disdain for science and for evidence-based medicine.”
Still, there’s a strong chance Dr. Oz will be confirmed as head of CMS. Although RFK Jr.’s plans for Medicare and Medicaid are unclear, Dr. Oz has been much more vocal about how to lead the CMS. This is particularly important given that the trust that funds Medicare is slated to be depleted by 2036. Dr. Oz will likely try to steer retirees and older Americans toward one specific type of Medicare coverage.
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Medicare Advantage plans
Medicare enrollees must choose between original Medicare (Parts A and B plus a Part D drug plan) and Medicare Advantage. Advantage plans are those offered by private insurers and must provide at least the same level of coverage as original Medicare. Many seniors are drawn to Medicare Advantage plans because they commonly offer supplemental benefits beyond what original Medicare covers.
In 2024, an estimated 99% of Medicare Advantage plans offered eye exams and/or glasses as a supplemental benefit, reports the Kaiser Family Foundation, while 98% offered dental care and 96% offered hearing exams and/or aids. These are services that original Medicare will not pay for, which commonly leaves enrollees with substantial out-of-pocket costs unless they enroll in a Medigap plan. While the costs associated with Medicare Advantage vary by plan, in 2024, 75% of enrollees paid no added premium besides the mandatory fee for Part B.
As of 2024, roughly 32.8 million people were enrolled in a Medicare Advantage plan. That accounts for 54% of the Medicare-eligible population. However, if confirmed as the head of CMS, Dr. Oz will likely try to increase these numbers.
Dr. Oz’s support for MA plans
Dr. Oz has long been a staunch supporter of Medicare Advantage plans. In a 2020 Forbes article he co-authored, Oz pointed out that Medicare Advantage enrollees get superior care thanks to competing plans. As the article stated, Medicare Advantage offers “much better benefits, care coordination, quality controls, levels of performance accountability and cash-flow models for implementing and delivering continuously improving models of care.” The article went further, though, proposing a new “Medicare Advantage for All” program that would provide coverage to every American who is not eligible for Medicaid.
Dr. Oz proposed funding such a program with “an affordable 20% payroll tax” to be split evenly among employees and their employers, similar to how FICA taxes are paid today. He also argued that a shift toward Medicare Advantage for All would save taxpayers money.
Whether the program would realize those savings is not settled. A 2023 report by the Physicians for a National Health Program found that Medicare Advantage overcharges taxpayers by anywhere from $88 billion to $140 billion per year.
Even if Medicare Advantage for All doesn’t take off, it’s likely that if confirmed to run CMS, Dr. Oz will, at the very least, try to expand Medicare Advantage enrollment. Whether that includes improvements to these plans, however, is yet to be determined.
Medicare Advantage plans have their flaws
Many consumers like their Medicare Advantage plans, but problems have been mounting. Most Medicare Advantage plans subject enrollees to prior authorization requirements that commonly lead to delays in care and, in some cases, denials of care. Enrollees have complained about unscrupulous or “hard sell” marketing tactics by some plans.
As of 2024, 99% of Medicare Advantage enrollees participated in plans with prior authorization requirements. These requirements can apply to expensive diagnostic tests, durable medical equipment and inpatient hospital stays. By contrast, original Medicare rarely requires prior authorization, eliminating bottlenecks and giving seniors quicker access to care.
Medicare Advantage plans also commonly limit participants to narrow provider networks, whereas enrollees in original Medicare can see any provider in the country where Medicare is accepted.
Conflicts of interest
New appointees under Trump may have conflicts of interest with the Medicare Advantage insurance industry in several ways.
President Trump has appointed Don Dempsey as associate director of the Office of Management and Budget’s health programs. This position grants Dempsey control over the CMS, and thus Medicare, purse. Dempsey most recently served as the vice president of policy and research at the Better Medicare Alliance, a lobbying organization for the Medicare Advantage industry. According to the Financial Times and Newsbreak, the organization is funded by Humana and UnitedHealth, the two largest Medicare Advantage companies in the U.S.
There’s also the question of Dr. Oz’s ties to healthcare companies and investments that have helped him amass his personal fortune — ties that present as a conflict of interest for anyone tasked with heading up CMS. The New York Times puts the value of his business and family ventures at $90 to $335 million.
In a recent ethics filing, Dr. Oz disclosed investments in a broad swathe of health-related companies and products. He has said that he would sell his positions in dozens of companies to avoid a conflict of interest. Those include as much as $600,000 in stock in UnitedHealth Group, the nation’s largest provider of the Medicare Advantage plans Dr. Oz has been known to tout.
Dr. Oz also pledged to resign from paid advisory positions.
But Dr. Oz’s financial entanglements leave questions about the nature of certain business relationships.
“I can’t even tell from his disclosures what direct or indirect arrangements he has,” Kathleen Clark, a law professor at Washington University in St. Louis who specializes in government ethics, told the New York Times. And even if Dr. Oz divests from companies that present a conflict of interest, he would also need to extricate himself from years of endorsements.
Christopher Krepich, a spokesman for Dr. Oz, said that Oz was cooperating with the Office of Government Ethics and would comply with its rules.
How Medicare may change
Whoever leads the CMS will likely favor Medicare Advantage plans over Medicare. After all, Project 2025, a controversial Heritage Foundation plan for overhauling the government that now has Trump’s support, has proposed making Medicare Advantage the default choice.
If Dr. Oz is confirmed to head up the agency, the hope is that he’ll also work to improve Medicare Advantage. For example, limiting the number of services subject to prior authorization could help streamline care for older Americans and potentially lead to better outcomes.
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