Why I Would Never Choose Medicare Advantage (16:45 but well worth the time)

After the hooping and hollering of the election season is done then comes the real work of governing. One of the most divisive of issues is health care. One of the biggest reasons is race. MAGA and their intellectual predecessors – Republicans and earlier Southern Democrats – refuse to “give” anything to the “others” in this society.

The “others” in this society are basically anyone who isn’t white and male. So that means blacks, women, Latinos and Asians and Pacific Islanders. One of their other criteria is that somebody make a profit, a big profit if possible, on health care.

So as I was listening to some NPR radio out of Minnesota – sort of a hobby of mine to listen to radio around the country – I heard a short story that a hospital system in Minnesota will quit taking a specific Medicare Advantage (I so hate that name) because their payment rate is so low and often very late if at all.

This is something that has been happening across the country for about a year or so. Medicare Advantage companies, just like their for profit cousins, makes money when they don’t pay for what should be covered services. 

This leaves the client with a bill at a time in life when their income is probably limited and their options to contest the bill are limited. Whatever service they got had been pre-approved and then the insurance company reversed their approval.

From Health Care Innovations  we get the story that is being repeated more and more frequently across the country:

The trend of health systems ending relationships with Medicare Advantage plans continues, with Essentia Health informing patients that, due to excessive prior authorization requirements and denial of care, it will no longer will serve as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare (UHC) and Humana, effective Jan. 1, 2025.

Duluth, Minn.-based Essentia Health is an integrated health system with 14 hospitals serving patients in Minnesota, North Dakota, and Wisconsin. It says that UHC and Humana delay and deny approval of care for its patients at more than twice the rate of other Medicare Advantage plans. This can cause unnecessary hardships for many Essentia patients, it claims.

“Like many other health systems, we have been re-evaluating our participation in Medicare Advantage plans that place added strain on our patients by too often denying or delaying their care,” said Cathy Cantor, M.D., M.B.A., Essentia’s chief medical officer for population health, in a statement. “This was not a decision we made lightly. The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve.”

Physicians for a National Health care Policy (PNHP) ran a story on this last fall.  

Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether.

Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.

“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s. “Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.”

In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners.

One reason to bring this up right now is that we are moving into the annual Medicare sign up period. The Advantage plans offer lots of baubles with. Their programs, but the basic package is unsound and filled with pitfalls. The most important pitfall is that they may not pay for a service leaving the client (you) stuck with a huge medical bill.

Medicare Advantage (did I mention I hate that name?) is a product of the George W. Bush presidency and a Republican dominated congress that essentially took our money and handed it to the privatized insurance companies. The insurance company’s goal is to make money, not your health.

So as you get inundated with Medicare schemes this fall you have been warned that Medicare Advantage