Federal Officials Propose Tougher Rules on Medicare Advantage Plans
This past Saturday, The New York Times reported that Federal Health officials are proposing an extensive set of tougher rules governing Medicare Advantage plans, in response to wide-scale complaints that too many patients' medical claims have been wrongly denied and that marketing of the plans is deceptive. Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that are frequently less expensive and provide a wider array of benefits than the traditional government-run program offers. Enrollment in these plans has doubled since 2011, and approximately 26.4 million people were enrolled in these plans in 2021.
Denials of Care
An April 2022 report reviewed a sample of denials of care and found that some of the services that were rejected would probably have been approved if the beneficiaries had been enrolled in traditional Medicare. The report found problems with prior authorization requirements that are not necessary in traditional Medicare, and also found problems with claims denials resulting from inaccurate processing of claims.
Deceptive Marketing
I believe you have all seen the relentless television advertising, with pleas from media stars and one long-retired quarterback (you know who I am talking about) to "GET WHAT YOU DESERVE AND CALL THIS 800 NUMBER NOW!" Calling that 800 number exposes seniors to multiple calls from high pressure Third Party Marketing companies, many of whom engage in deceptive sales tactics. This is a real problem and gives the entire industry a bad reputation!
Here is my view:
Denials of care are serious issues, and the Federal government should require that Advantage plans make whatever changes are necessary to reduce the problems.
Satisfaction studies indicate that the large majority of Medicare Advantage members are very satisfied with their plans. These plans will continue to grow.
I have many friends and colleagues who passionately believe that we should have a single payor system, and I am sure hem seniors would be happy with a standardized, government issued health plan. On the other hand, Medicare Advantage offers something that is attractive to many other seniors - choice of plans.
From a personal perspective, my wife and I are enrolled in a Medicare Advantage plan, and we are very pleased with it.
My clients seem to split 50-50 between traditional Medicare and Medicare Advantage plans. The choice is unique for each person, and depends on that person’s preferences – how much insurance are you willing to pay for, how much risk are you willing to take, how much and what kind of care do you anticipate, and (very important) what are the rules in your state about switching from a Medicare Advantage plan to a supplement plan down the road.
As I said above, these are very serious issues, and I am certain more information will be forthcoming. I will forward additional information to you as it becomes available.
If you have questions or concerns about how these issues affect your coverage, don't hesitate to call me at 978-447-3737.
Yours in good health,
Jeff
Jeffrey W. Werner
OTL Benefits