MASSIVE: Hospitals Are DROPPING Medicare Advantage Plans (32 minutes) 

NOTE: information on switching back starts at 28 minutes.

The open enrollment period is upon us. Once again we are seeing grizzly wise old dudes and spritely looking older ladies singing the praises of Medicare Advantage. Once more we must remind you that MA is private insurance. It is not Medicare and the only Advantage is to the insurance companies. 

I was reminded of all this yet again when I ran across an article discussing how the insurers were reassessing their markets to maximize their profits. Just like property insurance companies are fleeing Florida as the effects of the climate catastrophe magnifies its effects on that state, so are MA insurers doing what they can to avoid claims and maximize profits.

Do you get it? MA is not for the insured, it is profit driven companies for the stock holders. They will do whatever they must to maximize profits and minimize losses. The insured are not part of the equation. We recently did an article on this same thing only a few weeks ago when a large company decided to abandon an area of Minnesota MA coverage due to a rise in claims in that state. 

As another story came along revealing a larger national roll back and since this is within the sign up period I thought this would be a good time for another reminder. Since this is also election season, it is also a reminder that Republicans – now MAGAs – create situations that they sell as forward looking when their programs often have very poison pills for regular people while moving huge money and advantages to the already wealthy and well off.

The recent move to privatizing education in Iowa is a similar situation. While on the surface it looks like a chance for students and parents to find better schools, the underlying effects are to pay tuition for rich and wealthy parents while undermining and destroying our public school system.

Counterpunch published an article reminding us what is at stake as insurance companies spend millions and millions to finagle aging Americans to sign up for insurance programs that often do not live up to their billing.   

October 15 marks the first day of open enrollment in Medicare Advantage (MA) plans – a time that will deliver chaos and confusion for many of the 34 million seniors who depend on these plans to pay their healthcare bills. It’s yet another reminder that Medicare wastes billions of dollars funneling public money to private companies that are primarily driven by profit-seeking.

Last year, more MA members than expected used their benefits to get necessary medical care. One might assume that companies would expect beneficiaries to use health care services. But after years of making outsized profits, the insurance companies that own these plans are reacting to this by downsizing plans, cutting benefits, increasing copays, and raising prescription drug deductibles. In other words, Medicare Advantage beneficiaries are being penalized for using the health care that they pay for.

Insurers are Dropping Plans and Slashing Benefits

Having spent decades luring enrollees and collecting premiums, two of the biggest health insurers in the MA marketplace, CVS and Humana, are scaling back, slashing benefits, and canceling plans with too many members who used their health benefits. They are closing less profitable health plans that serve half a million or more seniors, forcing them to sign up for other more expensive or less generous coverage. Humana is set to leave 13 markets around the country, affecting 560,000 beneficiaries or 10 percent of its plan members. The reason for exiting? The CFO herself, Susan Diamond, said the specific markets just aren’t profitable. CVS Chief Financial Officer Tom Cowhey sent a similar message at a conference last month: “Could we lose up to 10 percent of our existing Medicare members next year? That’s entirely possible. And that’s okay because we need to get this business back on track.”

Medicare Advantage plans are being impacted all over the country. In Vermont, MVP and WellCare are dropping two MA plans in January 2025. This will affect 6,000 older Vermonters who will need to quickly choose new plans in the upcoming enrollment period. The MA plans cited spiking health care costs and lower Medicare reimbursements. WellCare, which is run by Centene Corp, pulled out of Alabama, Massachusetts, New Hampshire, New Mexico, and Rhode Island in addition to Vermont, leaving 40,000 people and 4 percent of MA beneficiaries without continued coverage past the enrollment period. In New Hampshire, multiple MA plans are shutting down, leaving tens of thousands beneficiaries scrambling. In Minnesota, nearly 60,000 people will face disruptions to their MA plans.

Health systems and hospitals are also making the decision to cancel contracts due to excessive prior authorization denial rates and slow payments from insurers. Already 27 health systems have canceled their Medicare Advantage contracts this year. MA plans can be especially harmful to rural providers who already face financial hurdles, and may further struggle to continue providing care to their communities due to unreliable and low reimbursements from insurers.