While the majority of Medicare Advantage insurers overturn prior authorization denials when those decisions are appealed, the appeal process adds additional delays to care that can harm both hospitals and patients. A recent Becker’s article ranked MA insurers by denial overturn rates and offered insight into which companies are the most and least likely to
Of the 38 counties in the U.S where Medicare Advantage enrollment is 75 percent or more, six are in Texas, according to analyses by the Kaiser Family Foundation. Nationwide, Medicare Advantage penetration is, on average, 54 percent, a proportion that increases each year. Starr County: 81 percent El Paso County: 76 percent Hidalgo County: 76
As Medicare Advantage plans face myriad challenges, including rising costs, negative media coverage, and increased lawmaker scrutiny, the health insurance industry is planning a major lobbying effort to boost support for the alternative to Traditional Medicare. With open enrollment beginning Oct. 15, the insurance industry hopes to avoid enrollment declines. From the article: The Medicare
A recent Kaiser Family Foundation analysis found an increase in prior authorization requests from 2019 to 2022, along with a rising share of requests that were denied. Summary Prior Authorization Request Increase: More than 46 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2022, up from
Becker’s Hospital Review summarized a recently released report from The Wall Street Journal that found Medicare Advantage plans collected $50 billion from diagnoses added to patients’ charts between 2018 and 2021, a third of which were added during home visits – even as the Medicare Payment and Advisory Commission recommends against insurers being paid for
A 2022 report from the Office of Inspector General examines the issue of prior authorization denials in Medicare Advantage plans. Here are the key findings: High Denial Rates: The report found that Medicare Advantage Organizations (MAOs) denied 13% of prior authorization requests, even though the services met Medicare coverage rules. Impact on Beneficiaries: These
The Kaiser Family Foundation summarized Medicare Advantage 2024 trends and updates in enrollment. Here are the main points: Enrollment Growth: In 2024, 32.8 million people are enrolled in Medicare Advantage plans, making up 54% of the eligible Medicare population. Plan Availability: The average Medicare beneficiary has access to 43 Medicare Advantage plans, the same
As more seniors advance into Medicare eligibility, Humana noted decreases in its Medicare Advantage population leading to new consideration for how it will approach its commercial Medicare products. Changes, according to Modern Healthcare reporting, will take place geographically and will include premium increases. Humana tinkers with Medicare Advantage plans amid higher costs July 31,
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