About Medicare Advantage and Prior Authorizatons - NY Times

Medicare Advantage (MA) plans, often referred to as Medicare Part C, are healthcare insurance plans that replace “original Medicare,” often doing so at little to no additional cost, while simultaneously offering additional services. The combination of additional services at low/no added cost is attractive, as evidenced by the growth of MA in recent years to the point that over half of all those eligible for Medicare are now enrolled in an MA plan. And MA plans, in spite of their restrictions on which providers a beneficiary can use, can, indeed, be exactly the right thing for many seniors. But, Medicare Advantage providers have been under increasingly intense scrutiny recently because of their propensity to require prior approval for many necessary healthcare procedures. Critics, including most medical service providers, say the MA plans are driven by profit thus incentivized to delay or refuse approval for procedures. Doctors complain that treatment is a matter between them and their patients, not the insurance company, as discussed in this New York Times article by Paula Span.

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