Medicare Advantage: God's gift to insurance companies, not patients

BENNINGTON — At the same time that more seniors are choosing Medicare Advantage (MA) over traditional Medicare, the very real drawbacks to MA are becoming ever clearer.

Opting for Medicare Advantage (MA) instead of traditional Medicare places decisions about your health in the hands of a big insurance company intent on making a profit: 75% of MA business is in the hands of six huge insurers.

The blizzard of commercials that these insurers fund with their profits tout the MA program as God's gift to seniors. But, unlike actual Medicare, these huge insurers have a great incentive to spend as little as possible on their insureds.

They accomplish this by, among other tactics, requiring that you get approval from them before getting many services, denying many of these requests, and denying or delaying payment to health care providers.

That's why the gross profit per insured on MA policies was more than twice as high as on other commercial insurance policies in 2021.

The Health and Human Services agency Inspector General recently found that 13% of pre-approval denials and 18% of payment denials were improper. Each denial saves these insurance companies money while imposing a real hardship on patients and medical providers. Not surprisingly, there seems to be a trend for providers to stop accepting Medicare Advantage, which leaves patients in a lurch.

Two San Diego area medical groups are canceling Medicare Advantage contracts because of low reimbursement and prior authorization hassles, leaving 30,000 enrolled seniors to look for new doctors, or different coverage.

The St. Charles health system in Bend Oregon may withdraw its participation in all Medicare Advantage plans, affecting 26,000 participants. It is urging participants to consider shifting to traditional Medicare.

Please keep this in mind as we proceed through the Medicare open enrollment period. It is not as easy as you may think to switch back to traditional Medicare after you decided to go with Medicare Advantage.

This Voices Letters from readers was submitted to The Commons.

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