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Health|Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html
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MEDICARE ADVANTAGE PLANS OFTEN DENY NEEDED CARE, FEDERAL REPORT FINDS
Investigators urged increased oversight of the program, saying that insurers
deny tens of thousands of authorization requests annually.
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Retired municipal workers at City Hall Park in Manhattan protested in February
against being switched to a Medicare Advantage plan.Credit...Lev Radin/Pacific
Press/ZUMA Press Wire, via Alamy
By Reed Abelson
Published April 28, 2022Updated Dec. 3, 2022
Every year, tens of thousands of people enrolled in private Medicare Advantage
plans are denied necessary care that should be covered under the program,
federal investigators concluded in a report published on Thursday.
The investigators urged Medicare officials to strengthen oversight of these
private insurance plans, which provide benefits to 28 million older Americans,
and called for increased enforcement against plans with a pattern of
inappropriate denials.
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 Advantage plans has more than doubled over the last decade, and
half of Medicare beneficiaries are expected to choose a private insurer over the
traditional government program in the next few years.
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The industry’s main trade group claims people choose Medicare Advantage because
“it delivers better services, better access to care and better value.” But
federal investigators say there is troubling evidence that plans are delaying or
even preventing Medicare beneficiaries from getting medically necessary care.
The new report, from the inspector general’s office of the Health and Human
Services Department, looked into whether some of the services that were rejected
would probably have been approved if the beneficiaries had been enrolled in
traditional Medicare.
Subscribe to The Times to read as many articles as you like.
Reed Abelson covers the business of health care, focusing on health insurance
and how financial incentives affect the delivery of medical care. She has been a
reporter for The Times since 1995. More about Reed Abelson
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