In case you missed it,
The Wall Street Journal (WSJ) reports that America's seniors are increasingly being denied coverage under their Medicare Advantage (MA) plans for medically necessary skilled nursing care. To get the care and coverage they need, seniors are leaving MA plans and opting to enroll in traditional Medicare, interrupting their care and raising costs for taxpayers in the process:
“Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home.
“The 85-year-old was so weak and fragile, her son said, that she couldn't even get herself out of bed. Her family felt she wasn't ready to leave the facility in New York City's Queens borough.
“So she dropped her UnitedHealth coverage and enrolled in the traditional version of Medicare run directly by the federal government."
Unfortunately, the WSJ's reporting shows this is not a limited case, but is increasingly the reality facing many of our nation's seniors:
“A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage's sickest patients dropping their privately run coverage just as their health needs soared …
“Plans run by the private insurers in the Medicare Advantage system are supposed to offer old and disabled people the same benefits they would get from traditional Medicare. The plans can be a bargain for people because they limit out-of-pocket expenses and often offer extra benefits such as dental care.
“As recipients get sicker, though, they may have more difficulty accessing services than people with traditional Medicare. That's because the insurers actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use."
More than half (
54 percent) of the eligible Medicare population is enrolled in a MA plan due to the allure of extra benefits and multiple premium options. However, as their care needs increase, many seniors are being denied coverage. As a result, the rate of seniors in the final year of their lives leaving MA plans for traditional Medicare doubled from 2016 to 2022, compared to other enrollees, according to the WSJ's reporting. The investigation also found that MA insurers netted more than $6 billion in savings during that period, but left the government and taxpayers with the tab.
The WSJ coverage is in line with a recent
report from the U.S. Senate Permanent Subcommittee on Investigations that detailed how three of the nation's largest MA insurers are increasingly denying post-acute care coverage to seniors and individuals with disabilities, resulting in limited access to critical care for hundreds of thousands of MA beneficiaries.
Clif Porter, president and CEO of the American Health Care Association and National Center of Assisted Living (AHCA/NCAL) said:“Insurers should recognize the value of post-acute care. When patients receive therapy in a skilled nursing facility after a hospital stay, they often return home. Rehabilitation therapy can help prevent future rehospitalizations, falls, or other detrimental, costly outcomes. For Medicare Advantage to deliver on its promise to America's seniors, post-acute care must be part of the package."
Long term and post-acute care providers have long advocated for more competition and transparency into the MA program and process. AHCA/NCAL, the American Medical Rehabilitation Providers Association (AMRPA), the National Association of Long-Term Hospitals (NALTH), the National Alliance for Care at Home (The Alliance) and LeadingAge issued a
joint statement last month warning of the harm caused when MA plans delay or deny access to post-acute care.
Read the full WSJ piece
HERE.