Storm Clouds Over Medicare Advantage? -

Medicare Advantage (MA) – healthcare plans from private insurers which replace “original Medicare” – have become all the rage in recent years because they frequently offer services beyond those covered by government-administered Medicare. Medicare Advantage plans typically include restrictions on which medical service providers are to be used, but also frequently include prescription drug coverage, dental and vision coverage, and other services at only a small additional cost. No wonder the plans are so popular, representing more than half of senior healthcare plans, but it appears that storm clouds are gathering over these popular alternatives to original Medicare.

Turns out that a number of major hospitals and medical services providers are losing money by accepting Medicare Advantage clients, citing excessive prior authorization denial rates and slow payments from insurers – so much so that they are refusing to accept private MA plans altogether. According to one source, Medicare Advantage has become “a game of delay, deny, and not pay,” even causing some medical service institutions to discourage patients from enrolling in Medicare Advantage. Add to this that the Federal government is investigating allegations of billing fraud by MA insurers, and the attractive aura of Medicare Advantage becomes a bit tainted, as explained in this Becker’s Hospital CFO Report by Jakob Emerson.

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