Medicare Advantage Headlines

For many patients who trusted their Medicare Advantage plans would be a helpful way to ensure care for the long haul, many are finding critical disadvantages ranging from gaps in local provider access to a lack of available promised services. For others, it can be worse. As Dave Lieber from the Dallas Morning News writes,

The disadvantages of Medicare Advantage programs can extend beyond frustration for patients and lower reimbursement rates for hospitals. A recent report from the U.S. Health and Human Services Department Office of Inspector General put a sharper focus on questionable practices in certain Medicare Advantage programs from certain commercial health insurance companies. Three health insurance companies

Medicare Advantage plans’ excessive denials, restrictive provider networks, and contentious contract negotiations continue to increase the number of health systems dropping MA plans. This new reality leaves patients frustrated and creates significant challenges for providers searching for a sustainable solution to provide care for MA enrollees – who are projected to make up 60 percent

Medicare Advantage plans denied 7.4 percent of medical professionals’ prior authorization requests, or about 3.4 million requests, according to a recent KFF analysis of 2022 data. With just 1 in 10 patients appealing these denials, prior authorization denial often means care is foregone. For Kendra Sollars and her family, a Medicare Advantage plan’s prior authorization

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