Federal Report Critical of Medicare Advantage Plans

In late April, The New York Times published an article about a report by the Office of Inspector General of Health and Human Services, regarding coverage provided by Medicare Advantage Plans.

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

The 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.

Report Recommendations

The report went on to recommend specific actions by Centers for Medicare Services to ensure that Medicare Advantage beneficiaries have timely access to all necessary health care services, and that providers are paid appropriately. 

Here is my view:

• These are serious issues, and the Federal government should require that Advantage plans make whatever changes are necessary to reduce the problems.

• 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. For example, the trade association of Medicare Advantage plans will most likely respond to the OIG report. 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 – “On The Level”