Medicare Advantage is losing providers.
Since being diagnosed with Crohn’s Disease about a year ago I have been on several medications, and diet changes of course.
The most recent, a combination of infusions and self injections, seems to be working. I am grateful for that.
The drug’s (Skyrizi) sticker price is incredibly expensive, but it is being paid for by my state teacher retirement Medicare Advantage plan except for a hundred dollar a dose co-pay.
It’s weird because the infusion is considered a medical procedure that comes without a co-pay and the self-injection is considered a part of my drug plan and comes with the co-pay. It’s the same drug.
Because of the expense, my state Aetna Medicare Advantage plan requires a prior authorization.
I have had several doctor approved procedures that needed Aetna’s prior authorization this past year. Four have been denied and were successfully appealed.
Every one is stressful.
Medicare Advantage plans get a bad rap.
All deserved.
MA plans are the pathway to privatized Medicare. Half of current Medicare recipients are enrolled in private insurance MA plans.
The Biden administration has continued the Trump administration’s attempts to move everybody in Medicare into a MA-like plan.
A growing number of hospitals and health systems nationwide are pushing back and dropping some or all contracts with 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.
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 San Diego area. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians.
Bend, Ore.-based St. Charles Health System took it a step further and was not only considering dropping all Medicare Advantage plans, but also encouraged its older patients not to enroll in the private plans during the current enrollment period which ends in December.
Thirteen other providers have dropped Medicare Advantage.
In October, the Nebraska Hospital Association issued a report detailing how Medicare Advantage is "failing patients and jeopardizing Nebraska hospitals."
York, Pa.-based WellSpan Health will no longer accept Humana Medicare Advantage and UnitedHealthcare-AARP Medicare Advantage plans starting Jan. 1.
Greenville, N.C.-based ECU Health said it anticipates it will no longer be in network with Humana's Medicare Advantage plans starting Jan. 1.
Raleigh, N.C.-based WakeMed went out of network with Humana Medicare Advantage plans in October.
Zanesville, Ohio-based Genesis Healthcare System is dropping Anthem BCBS and Humana Medicare Advantage plans in 2024.
Brunswick-based Southeast Georgia Health System will terminate its contract with Centene's WellCare Medicare Advantage plan on Dec. 8.
Liked other providers they blame unreasonable denials.
Nashville, Tenn.-based Vanderbilt Health went out of network with Humana's HMO Medicare Advantage plan in April.
Fayetteville, N.C.-based Cape Fear Valley Health dropped UnitedHealthcare Medicare Advantage plans in July.
Corvallis, Ore.-based Samaritan Health Services ended its commercial and Medicare Advantage contracts with UnitedHealthcare.
Cameron (Mo.) Regional Medical Center stopped accepting Cigna's MA plans in 2023 and plans to drop Aetna and Humana in 2024.
Stillwater (Okla.) Medical Center has ended all in-network contracts with Medicare Advantage.
Brookings (S.D.) Health System will no longer be in network with nearly all Medicare Advantage plans in 2024, with the exception of Medica.
Louisville, Ky.-based Baptist Health Medical Group went out of network with Humana's Medicare Advantage plans in September.