Federal Report Shows Medicare Advantage Plans Often Deny Needed Care

From Social Security Works (http://www.socialsecurityworks.org/):

The New York Times just dropped a bombshell writeup of a newly released federal report on Medicare Advantage, which lets private health insurers use Medicare dollars to run their own programs:

Medicare Advantage was created in 1997 with the classic rhetoric of privatization: more choices and competition would drive down costs and create a more efficient system, producing better care for less money. It sounded too good to be true and now, we have 25 years of proof that it is.

This study paints the clearest picture yet of how Medicare Advantage harms traditional Medicare while providing worse care for seniors. The report is stunning:

Based on its finding that about 13 percent of the requests denied should have been covered under Medicare, the investigators estimated as many as 85,000 beneficiary requests for prior authorization of medical care were potentially improperly denied in 2019.

Advantage plans also refused to pay legitimate claims, according to the report. About 18 percent of payments were denied despite meeting Medicare coverage rules, an estimated 1.5 million payments for all of 2019. In some cases, plans ignored prior authorizations or other documentation necessary to support the payment.

These denials may delay or even prevent a Medicare Advantage beneficiary from getting needed care, said Rosemary Bartholomew, who led the team that worked on the report. Only a tiny fraction of patients or providers try to appeal these decisions, she said.

“We’re also concerned that beneficiaries may not be aware of the greater barriers,” she said.

Here’s the bottom line: While corporate marketing campaigns can make Medicare Advantage seem like a good deal to seniors, these plans fundamentally alter Medicare’s promise. Instead of letting a patient and doctor choose the best course of care, the for-profit insurer determines what care the patient receives.

The corporate greed inherent in Medicare Advantage is driving up premiums for everyone on Medicare, even the ones who enroll in traditional Medicare. If left unchecked, corporate greed will cost Medicare an additional $85 billion.

Privatized health care is only good for one group: corporate insurers. That’s why we need to improve traditional Medicare and expand it to cover everyone in America.