1 million+ patients lose coverage as insurers, hospitals drop Medicare Advantage

Medicare is the federal health insurance program for people over 65 and those with certain disabilities. Medicare Advantage is a version of Medicare run by private insurance companies that contract with the government. These plans typically offer extra benefits, such as dental, vision and prescription drug coverage, that aren’t included with traditional Medicare. More than half of eligible Medicare beneficiaries now get their coverage through private Medicare Advantage plans.

But this year, as Medicare’s open enrollment season kicks off, more than 1 million patients will have to shop for new health insurance. Facing financial and federal regulatory pressures, many insurers are pulling their Medicare Advantage plans from counties and states they’ve deemed unprofitable. Meanwhile, large health systems in states including Alabama, Minnesota and Vermont have cut ties with some Medicare Advantage plans.

It’s a situation that’s alarmed state insurance regulators, who are fielding questions from older adults concerned about their hospitals and doctors withdrawing from their Medicare Advantage plans. Last month, the National Association of Insurance Commissioners sent a letter to the federal Centers for Medicare & Medicaid Services asking for guidance.

“Beneficiaries are faced with either paying the increased out-of-network costs or rescheduling their necessary medical services with another provider who may not have prompt availability,” the insurance commissioners’ group wrote. “A delay in access to medically necessary services is likely to result in harm.”

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1 million+ patients lose coverage as insurers, hospitals drop Medicare Advantage

Libby and Andrew Potter usually ignore the avalanche of Medicare Advantage ads that land in the mailbox at their home in Huntsville, Alabama, each fall as

americanmilitarynews.com

 

[Ghoti Ichthus]

I just looked at Minnesota. There are a couple of out-of-state systems that are leaving in-network for a couple of insurance companies' Advantage plans because of financial losses at specific facilities. There's a Minnesota-based nonprofit system that operates two hospitals, one of which is the hospital in downtown Minneapolis that gets huge numbers of indigent, homeless, addicted, uninsured, mentally ill, Medicaid, and Medical Waiver patients through their ER and transferred (dumped) from other hospitals, and the other being in a lower income area with a high percentage of patients on government plans, which pay less than commercial plans. There are two other Minnesota nonprofits, which cite insurance company non-payment, delayed payment, and high rates of denials that adversely impact patient treatment.

 

[LydiaJoy]

Good riddance. Medicare Advantage is bad for patients and bad for investors:

https://www.statnews.com/2024/02/28...verpayment-patient-dissatisfaction-investors/

“Medicare Advantage isn’t working for any group: the government, patients, taxpayers, and now even investors.”

“Many seniors say they feel trapped in the program, tricked into joining with promises of quality care and low costs, only to find their treatments denied and bills piling up when they become ill. A recent report from the Commonwealth Fund found that more Medicare Advantage patients (22%) than traditional Medicare patients (13%) reported delays due to insurance approvals. With all these issues, hospitals are increasingly refusing to accept MA at all, citing low reimbursement rates and excessive prior authorization as heavily burdensome to their work.”

“The truth is that MA has been a broken system since the beginning, especially for patients. The business worked only as long as insurers were able to extract inappropriately large payments from the Medicare fund through methods like upcoding, where plans list false or exaggerated diagnoses on patient charts to get more money while providing no additional care. In fact, the MA model relies on providing as little care as possible in general, with insurers putting care approval behind a wall of delays and denials to save money and leaving patients suffering without necessary treatment. Now that the government is trying to rein in these abuses and seniors are using more health care than before, this model is in serious jeopardy.”

Private plans have no business administering Medicare benefits…

 

[Andiamo]

My Mom signed up for Humana without my knowledge beforehand and stays on it despite my telling her over and over how risky it is. It really ticks me off how these companies trick people.

 

[Ghoti Ichthus]

My Mom signed up for Humana without my knowledge beforehand and stays on it despite my telling her over and over how risky it is. It really ticks me off how these companies trick people.

Is she on an Advantage plan or is it a Supplement? Huge difference in what they'll approve and deny.

 

[Tall Timbers]

I don't understand the difference between an advantage plan and a supplement. Which is tricare for life?

 

[Armor of Light]

I live in Nebraska, I have the Advantage plan through United Health Care and it has worked for me for 5 years, now what am I suppose to do, I hate wading through all these different plans trying to find the right plan, and will all states drop MA coverage, so tired of all the health care mess.

 

[Andiamo]

Is she on an Advantage plan or is it a Supplement? Huge difference in what they'll approve and deny.

I don't understand the difference between an advantage plan and a supplement. Which is tricare for life?

I don’t understand all of this either. It’s all so confusing and purposely that way I believe.
All I know is that she doesn’t pay anything for it, (“why wouldn’t I want it? It’s free” she says) and she gets a free “Silver Sneakers” gym membership. That she doesn’t use.

 

[Andiamo]

I sent her this video last night to try to at least wake her up. This guy seems to be very knowledgeable and good at explaining things. I only watched a few minutes if it. - YouTube

 

[bigMoose]

I think both these cases were Medicare advantage... and it hurt our family.

My aunt became very ill and my Mother wanted her to come and live with her, where she and us, could help with her care. Because my aunt's health care was limited to the geographical area in which she lived we could not move her out of state and have any coverage.

Fast forward 5 years and the same happened with my mother in law. We could not move her out of the geographical area of her coverage.

Both ended up in nursing homes... not with family.

 

[Cheeky200386]

Licensed Mental Health Counselors were just approved to join Medicare networks as of January 2024. If you didn't want to be in network, you had to write a letter stating that. I did that instantly. One of my friends was already on their panel as a social worker in private practice. She told me she avoids accepting clients with Medicare because it took one year for her to get payment for services she had already offered. That was after many hours and months on phone calls trying to get a hold of someone from Medicare. She let me know I made the right choice declining their network.

Taking Medicare would result in me closing my practice. It's unfortunate but the reality. Insurance is becoming harder to justify taking because they make it difficult to recieve payment and if you do get paid, the rates are getting lower and lower each passing year. I currently only take two insurances and I'll probably keep it that way for the time being. They are decent paying and are easy to deal with. I just tried to get on the NH BCBS panel and received their rates. They are lower than what I offer to clients on a sliding scale. It was insulting and I couldn't afford to take them so I wasted time going through their hoops only to see their measly pay rates.

Everyone complains there is a mental health crisis, not enough counselors but nobody goes after the insurance companies that want to refuse services, refuse payment, and then want to pay counselors enough for them to have to close their doors or have to work 100 hours a week in order to stay afloat. How does that work?!

 

[Tall Timbers]

Taking Medicare would result in me closing my practice. It's unfortunate but the reality. Insurance is becoming harder to justify taking because they make it difficult to recieve payment and if you do get paid, the rates are getting lower and lower each passing year.

I get care through the VA. For a lot of things they farm me out to local practitioners. For my last pain management treatment the total bill from the hospital was around $18000 which to me was ridiculously high, but if I was paying out of pocket that's the amount I'd be expected to pay. The VA authorized a payment of around $1200 for the procedure which to me seemed ridiculously low... I don't know but I suspect that what the VA pays out is probably similar to medicare allowances. Doctors have a lot of overhead and I don't know how some of them manage with the payments for services they ultimately receive from the insurers.

 

[Cheeky200386]

I get care through the VA. For a lot of things they farm me out to local practitioners. For my last pain management treatment the total bill from the hospital was around $18000 which to me was ridiculously high, but if I was paying out of pocket that's the amount I'd be expected to pay. The VA authorized a payment of around $1200 for the procedure which to me seemed ridiculously low... I don't know but I suspect that what the VA pays out is probably similar to medicare allowances. Doctors have a lot of overhead and I don't know how some of them manage with the payments for services they ultimately receive from the insurers.

I’m sure there are providers that are greedy and are overcharging too. Money definitely has the ability to attract greed and corruption. I’m blessed that God keeps providing for me and allows me to help clients that can’t afford my full rate. I will keep offering affordable rates as long as I can but I suspect things will get harder as things get more expensive and if people keep losing their jobs.


I used to only have one or two clients needing financial hardship rates and now it seems like every other client that I have is needing it. Mainly because of new employers offering insurances that nobody takes. That’s becoming so common now. Or I also see that almost every other person has extremely high deductibles.

 

[Ghoti Ichthus]

I get care through the VA. For a lot of things they farm me out to local practitioners. For my last pain management treatment the total bill from the hospital was around $18000 which to me was ridiculously high, but if I was paying out of pocket that's the amount I'd be expected to pay. The VA authorized a payment of around $1200 for the procedure which to me seemed ridiculously low... I don't know but I suspect that what the VA pays out is probably similar to medicare allowances. Doctors have a lot of overhead and I don't know how some of them manage with the payments for services they ultimately receive from the insurers.

Yes, VA and VCCN rates are the same as Medicare rates.

The VA pays pretty quickly from what I understand.
Medicare and most insurance companies, not so much

 

[Ghoti Ichthus]

I don't understand the difference between an advantage plan and a supplement. Which is tricare for life?

Simplest explanation:

Medicare Advantage = HMO, which is far more likely to deny and/or limit (RATION) services, especially as one gets older. Many of these plans offer low or no premiums, and additional benefits like vision, dental, gym memberships, etc., and some include prescription coverage. BUT, the patient has to be seen in-network or pay out-of-network prices, which are often very high, or out-of-network is denied altogether. News reports indicate payment to providers is much slower on at least some of these plans. This mirrors news reports about Medicaid payments to providers. Medicaid is State-run with different rules and coverages in different states, etc. Medical waiver and similar programs are also State and sometimes County programs with different rules and coverages in different places.

Medicare Supplements pay what Medicare doesn't, which is typically 20 percent, for Medicare-covered services. Not sure how in-network vs out-of-network works because Dad's medical care was all in-network. Under Dad's supplement, some pharmacies were "preferred," and no or much lower copay for prescriptions. Dad never had to get pre-authorization for anything because he had Medicare plus the supplement, and a separate Part D (prescription) plan. The doctors' offices and the hospital knew what was covered and not covered by Medicare and his Part D, so no surprise bills. One thing that his primary care doc did for him was order a year's supply of his medication that had a very high copay so he could get it all in January and avoid being in the "donut hole" for that prescription. The donut hole is the gap between the initial coverage for prescriptions and the catastrophic coverage for prescriptions. It creates a lot of hardship and often non-filling/not taking prescriptions, especially expensive ones


Tricare for Life is free to military retirees and works like a Medicare Supplement (NOT an advantage or HMO plan). They call it a Medicare-wrap-around. It pays what Medicare doesn't, so long as one has Medicare Parts A and B. I don't know what pre-authorizations are like, but I found out I didn't need a referral from either a VA or Medicare/TFL provider for an Endocrinologist or Gynecological Oncologist under Medicare/TFL (although an individual provider may require one). HOWEVER, I can't use both VA and Medicare/TFL for the same visit. I have to pick one or the other for a specific visit. Prescriptions from a Medicare provider can be filled at the VA, but there are a couple of hoops to jump through, and if it's not in the formulary, or depending on the tier, or depending on supplies, specific medical use, etc., MAY be denied or substituted. There are differences in what is covered and not covered by VA/VA CCN/VA referrals and Medicare/TFL. AND, if I run out of VA CCN visits for something and not yet eligible for an additional referral/delay in the new referral, I can use Medicare/TFL for an additional visit(s) if it's something Medicare/TFL covers.


Note that it is possible to be on more than one program simultaneously. My Mom was on Medicare with Supplement, Medicaid, and Medical Waiver simultaneously when she was in the nursing home. Minnesota will recoup as much as possible of what they paid in Medical Waiver for Mom's nursing home care from sale of my Parents' house. They can (and will) take everything except the State-allowed $3000. Medical waiver here makes a huge difference in quality of nursing homes for everyone because money is coming in to care for residents, who otherwise would not be paying anything or not very much. This tax-funded program recoups what it can from specific assets after both husband and wife die and puts it back into the program to help the next person/people.

 

[Tall Timbers]

Tricare for Life is free to military retirees and works like a Medicare Supplement (NOT an advantage or HMO plan). They call it a Medicare-wrap-around. It pays what Medicare doesn't, so long as one has Medicare Parts A and B. I don't know what pre-authorizations are like, but I found out I didn't need a referral from either a VA or Medicare/TFL provider for an Endocrinologist or Gynecological Oncologist under Medicare/TFL (although an individual provider may require one). HOWEVER, I can't use both VA and Medicare/TFL for the same visit. I have to pick one or the other for a specific visit. Prescriptions from a Medicare provider can be filled at the VA, but there are a couple of hoops to jump through, and if it's not in the formulary, or depending on the tier, or depending on supplies, specific medical use, etc., MAY be denied or substituted.

I think the VA may sometimes bill Medicare for some of its costs. I've never used Medicare directly, but have paid for it because the way it's setup if you don't pay for it and someday need it, it could cost a King's ransom.

 

[Ghoti Ichthus]

Me too.
Plus it gives me options if I can't get the care I need, am unhappy with the doc, or need a truly independent 2nd opinion not paid for by the VA.

Sometimes the VA is so focused on serving as many as possible that Vets that aren't in the 99 percent end up with inadequate care because practitioners don't see certain things very often or at all.