Federal Report Targets Medicare Advantage Plans

Jerry S. Pearlstein Insurance has advised using Original Medicare with Medicare Supplements rather than Medicare Advantage plans across the 20 years of our practice. The AARP Bulletin June 2022 article quoted below offers more reasons to follow that advice.

Medical Care Wrongfully Denied

Private health insurance plans for Medicare beneficiaries wrongly denied tens of thousands of requests for tests and treatment each year, jeopardizing the health of many older Americans according to a top federal watchdog overseeing the program.

The inspector general called on the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, to more tightly regulate these plans to make sure they are following Medicare’s rules for what should be covered. CMS agreed with the findings and said the agency is weighing its next steps.

Private insurers receive a flat monthly fee for every Medicare beneficiary they cover. Investigators said this created “the potential incentive for insurers to deny access to services and payments in an attempt to increase profits.”

Under original Medicare, the federal government pays providers directly for each service or treatment Medicare covers.

The MA plans can require pre-authorization for a test or treatment. Federal investigators reviewed a week’s worth of those requests in 2019 and found that of those denied, 13 percent would have been allowed under original Medicare. Based on that sampling, inspectors estimated 85,000 requests would have been wrongly denied that year.

And that would “delay or prevent beneficiary access to medically necessary care, lead beneficiaries to pay out of pocket for services that are covered by Medicare, or create an administrative burden for beneficiaries or their providers who choose to appeal the denial,” the report says.

Americans approaching 65, the age of Medicare eligibility, are bombarded with Medicare Advantage marketing. If you, or someone you care about, are in this situation, please call us for a free, no obligation phone call. We’ll advise you through the whole process and always be available to handle questions or concerns. Call 847-362-8888.

Here’s to good decisions for good health and a good life.