Buyer beware: Medicare Advantage plans have red flags – InsuranceNewsNet

InsuranceNewsNet — Your Industry. One Source.ā„¢

Sign in
  • Subscribe
  • About
  • Advertise
  • Contact
Home Now reading Newswires
Topics
    • Life Insurance News
    • Annuity News
    • Health/Employee Benefits
    • Property and Casualty
    • Advisor News
    • Washington Wire
    • Regulation News
    • Sponsored Articles
    • Monthly Focus
  • INN Exclusives
  • NewsWires
  • Magazine
  • Webinars
  • Free Newsletters
Sign in or register to be anĀ INNsider.
  • Exclusives
  • NewsWires
  • Magazine
  • Webinars
  • Free Newsletters
  • Insider Pro
  • About
  • Advertise
  • Editorial Staff
  • Contact
  • Newsletters

Get Social

  • Facebook
  • Twitter
  • LinkedIn
Newswires
Newswires RSS Get our newsletter
Order Prints
August 12, 2022 Newswires No comments
Share
Share
Tweet
Email

Buyer beware: Medicare Advantage plans have red flags

Sedalia Democrat (MO)

A recent report by the federal Department of Health and Human Services Office of Inspector General (OIG) revealed a trend among some Medicare Advantage plans of inappropriately denying or delaying care for plan holders. In many cases, these claims would otherwise be covered under traditional Medicare. As a result, many people are either paying for services out of pocket or going without care.

Medicare Advantage (MA), or "managed care," plans are all-in-one alternatives to traditional Medicare and are provided by private insurers. They are designed to offer more comprehensive coverage than traditional Medicare, including fitness programs and vision, hearing and dental services. Many MA plans limit coverage to in-network providers and also set a limit on yearly out-of-pocket costs for covered services.

Maggie Schaffer, Director of Case/Quality Management at Bothwell Regional Health Center, said that only one skilled residential facility in Sedalia currently accepts managed care plans, making it difficult for some patients to receive the short- or long-term medical care they need locally after leaving the hospital.

Related stories

  • Assurant Earns 2023 Great Place to Work Certificationā„¢ in the U.S.
  • Wilkes-Barre/Hanover levee gets accreditation recommendation [The Citizens' Voice, Wilkes-Barre, Pa.]

"Occasionally, the facility may try to get a one-time contract, but this is a long shot for them," she said. "If a patient has a Medicare Advantage plan, we often have to look outside of Sedalia for a facility that will accept the coverage."

Since Medicare Advantage plans are provided by private companies, they can have individualized rules of service, such as requirements for specialist referrals. Companies that provide MA plans also make the decisions on approving or denying care and often require prior authorization for services that would automatically be covered under original Medicare.

According to the OIG report, millions of patients have been denied care by their MA plan provider even though their doctors have deemed it medically necessary or beneficial. These denials happen in part because sometimes clinical criteria used by MA plans to determine coverage can be more strict than that of traditional Medicare. The OIG stated that about 13% of denied prior authorization requests met the criteria for coverage, as did 18% of denied payment requests.

"We get denials for inpatient care or skilled nursing on a regular basis," Schaffer said. "We try to do mediation, but we are not always successful."

Patients who have been denied coverage have the option to appeal the decision, but Schaffer said that process can be lengthy, resulting in further delay of care.

"An appeal for a patient is usually pretty overwhelming," she said. "They don't always have the words to have a decision overturned — they just know they are sick, and their doctor wants them in the hospital."

The popularity of MA plans has increased dramatically during the past 10 years, and enrollment numbers continue to rise. Currently, over 28 million people are covered under a private Medicare Advantage plan.

Schaffer said people who are considering or are currently covered by an MA plan should be aware of the findings of the 2022 OIG report and should weigh the advantages of an MA plan against the potential risks of denied coverage.

"Check with your local skilled nursing home, medical equipment company and home health company and see if they accept your insurance," she said. "Don't only rely on what the company selling the plan tells you, and if you have a Medicare Advantage plan, understand your right to an appeal and be familiar with the appeals process."

Older

Foursurance Agency, LLC Joins SAN Group

Newer

Workers Compensation Insurance Market to See Booming Growth : Tokio Marine, Liberty Mutual, Berkshire Hathaway

Advisor News

  • Fed slows rate hikes even as Powell says there's more work to do
  • Mortgage rates in U.S. fall again, hit 6.09%
  • 1 in 3 Americans struggling financially but goal-setting is a game-changer
  • Advisors bet on US stocks to outperform in 2023 amid tech rebound
  • Investors want more ESG information from companies
More Advisor News

Annuity News

  • Study: Does pessimism really suppress annuity sales?
  • Sweet streams of income: ChatGPT, the bard of annuities
  • F&G Annuities & Life announces equity investment in life IMO SYNCIS
  • Investors scrambling to lock in rates propel annuity sales to record highs
  • North American and Annexus launch new fixed index annuity
Sponsor
More Annuity News

Health/Employee Benefits News

  • Will plan fix California health care?
  • Insurance giant Elevance to move into 15th state
  • Medicare card scam targets seniors for personal info
  • Yes, states are re-checking Medicaid and CHIP eligibility starting in April
  • Annual wellness exam is key to a healthy year for older adults
More Health/Employee Benefits News

Life Insurance News

  • Chris Wilson tells court former friend Murdaugh confessed he was ā€˜stealing money’
  • State's motive testimony could prolong Alex Murdaugh murder trial
  • Equitable expands portfolio in VUL market
  • New date set for billionaire suspect accused of bribing state cabinet member
  • House approves bill protecting life insurance payouts from bankruptcy
More Life Insurance News

- Presented By -

Top Read Stories

  • Chicago news roundup: PPP fraud uncovered in Chicago, informant reveals $100K bounty on FBG Duck and more
  • Gov. Carney: Enrollment on Delaware's Health Insurance Marketplace for 2023 Reaches All-Time High
  • 25 people charged in fake nursing diploma operation
  • Missouri Department of Insurance: Over $24 Million Returned To Missouri Insurance Consumers In 2022
  • Connecticut addressing broker shortage amid The Great Unwinding
More Top Read Stories >

FEATURED OFFERS

Meet Encova Life
We know agents matter. You can count on our life team to be high tech, high touch and responsive.

How to Write For InsuranceNewsNet

Find out how you can submit content for publishing on our website.
View Guidelines

Topics

  • Life Insurance News
  • Annuity News
  • Health/Employee Benefits
  • Property and Casualty
  • Advisor News
  • Washington Wire
  • Regulation News
  • Sponsored Articles
  • Monthly Focus

Top Sections

  • Life Insurance News
  • Annuity News
  • Health/Employee Benefits News
  • Property and Casualty News
  • AdvisorNews
  • Washington Wire
  • Insurance Webinars

Our Company

  • About
  • Editorial Staff
  • Magazine
  • Write for INN
  • Advertise
  • Contact

Sign up for our FREE e-Newsletter!

Get breaking news, exclusive stories, and money- making insights straight into your inbox.

select Newsletter Options
Facebook Linkedin Twitter
Ā© 2023 InsuranceNewsNet.com, Inc. All rights reserved.
  • Terms & Conditions
  • Privacy Policy
  • AdvisorNews

Sign in with your Insider Pro Account

Not registered? Become an Insider Pro.