Your Medicare Plan May Have Been Bought, Not Chosen

What Happened

The U.S. Department of Justice filed a complaint against three of the country’s largest health insurers: CVS Health’s Aetna, Elevance Health (formerly Anthem), and Humana. These companies are accused of paying hundreds of millions of dollars in illegal kickbacks to insurance brokers to push Medicare Advantage plans from 2016 to 2021.

The DOJ says the payments were ostensibly meant for marketing and sponsorship fees. In reality, they were allegedly used to steer American seniors into specific plans that benefited the insurers as opposed to the patients. The lawsuit also names three major brokers as key players in the alleged scheme: eHealth, GoHealth, and SelectQuote.

The complaint also claims that Aetna and Humana went a step further. They allegedly pressured brokers to enroll fewer disabled patients, who tend to require more expensive care, in favor of healthier and more profitable enrollees.

The case was originally sparked by a whistleblower complaint in 2021. But now that the federal government is formally intervening, it’s escalating quickly. All companies involved deny wrongdoing and say they’ll fight the charges.

Why It Matters

This case targets a major and growing part of American healthcare. Medicare Advantage, the private alternative to traditional Medicare, now covers more than half of all Medicare beneficiaries, totaling over 30 million people.

Should the government’s allegations hold up, it would mean that millions of Americans may have chosen or been pushed into health plans based on broker commissions rather than their own healthcare needs. That’s not just unethical. It could be illegal under the False Claims Act, which prohibits false or misleading claims made to get federal funds.

Beyond ethics, there is also a consequential financial impact, as Medicare is funded by taxpayers. If these insurers did manipulate the system to collect extra payments from the government, those costs would have rippled out into the public. This could happen through higher taxes, reduced services, or increased scrutiny of benefits.

How It Affects You

For anyone on Medicare, this lawsuit is a wake-up call. It’s a reminder to be cautious about how you choose plans and who advises you.

Just because a broker or online marketplace offers 'free help' doesn’t mean their guidance is unbiased. Always ask how they're paid and whether they’re incentivized to sell certain plans. Brokers often serve who pays the highest commissions, and those plans are oftentimes not the most suitable.

This case could lead to a much tighter ruleset on how Medicare Advantage plans are marketed and sold. While that would be a win for transparency, it may also make the system more complex for individuals who are trying to compare coverages.

For those not on Medicare, this case spotlights a broader truth about American healthcare. When profit incentives aren’t aligned with patient care, people get hurt, and the costs eventually reach all of us.

As this lawsuit unfolds, it could reshape how health plans are sold, how brokers operate, and how the government enforces fairness in healthcare. In the meantime, patients and caregivers should stay sharp, ask questions, and remember that when it comes to insurance, trust is essential, but always verify.