REJECTED: American Academy of Ophthalmology: It's Medicare Open Enrollment Time – Beware of Plan Restrictions That Limit Access to Sight-Saving Care
As millions of Americans review their health insurance options during Medicare open enrollment, the
Medicare's fall open enrollment period will end on
Medicare Advantage plans, the private plan alternative to original Medicare, have become a significant part of the health insurance landscape over the last decade. A recent report from the
Unfortunately, some Medicare Advantage plans include frustrating restrictions - often buried deep in the fine print - that limit access to critical procedures and treatments. But most people don't find out about them until it's too late. More than 70 percent of Medicare beneficiaries do not compare plans, according to additional KFF analysis (https://www.kff.org/medicare/issue-brief/seven-in-ten-medicare-beneficiaries-did-not-compare-plans-during-past-open-enrollment-period/?mkt_tok=ODUwLVRBQS01MTE). As insurers have moved to increase the use of prior authorization, it is more critical than ever for consumers to carefully review the details and inquire with plan representatives about care obstacles they may encounter.
For example,
Requiring prior authorization for certain treatments or conditions is a growing trend in the health care insurance industry, one with devastating consequences for patients and physicians. According to an
As a result of
"
In addition to prior authorization, seniors should closely review Medicare Advantage plans' Part B drug formularies for restrictions and limitations. One of these restrictions, called step therapy or "fail first," requires beneficiaries to try and "fail" on an insurer-preferred medication before the insurer will cover the therapy prescribed by their health care provider.
"Medicare beneficiaries receiving Part B covered drugs include some of the most vulnerable patients in the program - those with cancer, progressive blinding eye diseases, rheumatic diseases, multiple sclerosis and compromised immune systems, among others," said
Medicare beneficiaries are frustrated by insurance company restrictions like prior authorization and step therapy. The AAO, ASCRS, and the
"The RRC is proud to have been on the ground floor as the bill was created and advanced," said
The majority bipartisan bill now has 239 co-sponsors in the House and was recently introduced in the
"Consumers have an opportunity right now to protect themselves from undesirable insurance policies that don't serve their best interests," said
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REPORT: https://www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf
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