Latest News
Prior Authorizations for Medicare Advantage have surged - ACHI
Medicare Advantage is offered by private insurers and provides replacement private healthcare coverage for those eligible for “original Medicare.” These private Advantage plans often offer healthcare coverage equal to original Medicare, but often enhanced by additional services such as dental, vision, and/or prescription drugs at a nominal additional cost. Sounds like a great deal, but there is more to consider: those on a Medicare Advantage plan may be required to use only healthcare providers in the plan’s “network,” thus restricting free access to all providers as is available with original Medicare. And, Advantage plans are well-known for requiring pre-approval of many healthcare services. For comparison, a recent study revealed that Medicare Advantage plans processed nearly 50 million Prior Authorization request in 2023, vs. only about 400,000 prior authorizations processed through “original Medicare.” This rising Medicare Advantage issue is discussed in this ACHI (Association for Community Health Improvement) article. Although this article specifically references Arkansas Medicare Advantage, the issue is a nationwide one. Click here to read more.