Hospitals are dropping Medicare Advantage plans left and right: 13 updates

Backers Hospital Reviee ^ | November 16, 2023 | Jakob Emerson

[buckalfa]

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 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.

"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.

Mr. Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene's Health Net and a few more smaller carriers. The system will remain in network for about 13,000 MA enrollees who receive care through Scripps' individual physician associations.

"If other organizations are experiencing what we are, it's going to be a short period of time before they start floundering or they get out of Medicare Advantage," he said. "I think we will see this trend continue and accelerate unless something changes."

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 upcoming enrollment period in October. The health system's president and CEO, CFO and chief clinical officer cited high rates of denials, longer hospital stays and overall administrative burden for clinicians. Ultimately, the health system has decided to remain in network with four MA carriers and will not renew contracts with three.

"We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist," St. Charles Health CFO Matt Swafford said.

"I feel terrible for the patients in this situation; it's the last thing we wanted to do, but it's just not sustainable with these kinds of losses," Mr. Van Gorder added. "Patients need to be aware of how this system works. Traditional Medicare is not an issue. With these other models, seniors need to be wary and savvy buyers."

Here are 13 more recent instances of hospitals dropping Medicare Advantage contracts:

In October, the Nebraska Hospital Association issued a report detailing how Medicare Advantage is "failing patients and jeopardizing Nebraska hospitals," 33% of which do not accept MA patients. The report cited negative patient experiences, post-acute placement delays, and administrative and financial burdens on hospitals that accept MA patients.

York, Pa.-based WellSpan Health will no longer accept Humana Medicare Advantage and UnitedHealthcare-AARP Medicare Advantage plans starting Jan. 1. UnitedHealthcare group MA PPO and Humana employer PPO MA plans will still be accepted.

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. According to CBS affiliate WNCN, the plan provides coverage to about 175,000 retired state employees. WakeMed cited a claims denial rate that is "3 to 4 times higher" with Humana compared to its other contracted MA plans.

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. The system said it started negotiations with the carrier after years of "inappropriate payment claims and 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. The five-hospital, nonprofit health system cited slow "processing of requests and claims" that have made it difficult to provide appropriate care to UnitedHealth's members, which will be out of network with Samaritan's hospitals on Jan. 9. Samaritan's physicians and provider services will be out of network on Nov. 1, 2024.

Cameron (Mo.) Regional Medical Center stopped accepting Cigna's MA plans in 2023 and plans to drop Aetna and Humana in 2024. It plans to continue Medicare Advantage contracts with UnitedHealthcare and BCBS, the St. Joseph News-Press reported. Cameron Regional CEO Joe Abrutz previously told the newspaper the decision stemmed from delayed reimbursements.

Stillwater (Okla.) Medical Center has ended all in-network contracts with Medicare Advantage plans amid financial challenges at the 117-bed hospital. The hospital said it made the decision after facing rising operating costs and a 22% prior authorization denial rate for Medicare Advantage plans, compared to a 1% denial rate for traditional Medicare.

Brookings (S.D.) Health System will no longer be in network with nearly all Medicare Advantage plans in 2024, with the exception of Medica. The 49-bed, municipally owned hospital said the decision was made to protect the financial sustainability of the organization.

Louisville, Ky.-based Baptist Health Medical Group went out of network with Humana's Medicare Advantage plans in September, Fox affiliate WDRB reported. The system will also go out of network with UnitedHealthcare and Centene's WellCare on Jan. 1 without a new agreement in place

[sneakers]

You're welcome! I did my research on Youtube. Type in "Medicare supplements" and there are a number of agents who explain how it works.

One important thing to note: There are four parts to Medicare: Parts A, B, C and D.

Parts A and B are original Medicare. It pays 80% of hospital procedures, dr visits, etc.

Part C is Advantage Plans. If you choose part C, you are NOT on medicare; you are with an insurance company.

Part D covers medications

If you decide to stay on original medicare, you can purchase a supplement (medigap) plan to cover the remaining 20%. The insurance company has NO SAY in whether you get a procedure done or not. They agree to pay the remaining 20%. If your doc says you need a knee replacement - you get it. Whatever your doctor says you need - you get. Also, you are not limited to a network. You can go to any dr who accepts Medicare, anywhere in the country.

On an Advantage Plan, the insurance company has to approve any procedure the doctor says you need, and you are limited to a network.

I hope this didn't make it more confusing. I spent hours watching videos explaining how it all works! It's not as hard to understand once you really dive into it!

[thinden]

“I signed up for standard Medicare.”

i’ve helped three people besides myself sign up, and had no problems ...

standard medicare (Part A and Part B) plus a standardized supplemental plan like Plan F or Plan G are the best medical insurance in the world, and for anyone who has significant and/or serious chronic issues, it’s the only way to go, because so-called advantage plans limit you to an EXTREMELY small set of providers, whereas almost ALL medical providers accept standard medicare ...

^^^^^^^^^^^^^^^^^^^^^

so where does the money come from to pay for the benefits offered on these zero premium medicare advantage plans?

does enrolling in these “so called advantage plans” that are “limited to an extremely small set of providers red-direct that $ 164+/- withheld from SSI checks go to pay the medicare advantage providers?

the money’s got to come from somewhere?

DOES ANYBODY KNOW THE ANSWER?

[mewzilla]

Deep State doesn’t like competition.

[unread]

"how much pressure do you think the illegal migrants are putting on the health care system costs?"

Well, apparently enough to destroy or at least disrupt the entire system.. I guess that's pretty much what's happening...

[G Larry]

Not Yet.

[gloryblaze]

... Where’s the money coming from to pay for all this if not the policy owners???

It has to be Uncle Sugar.

[Drago]

Medicare pays the “Advantage”.plan private insurance companies about $1K to $1200./mo. per enrollee depending on their Medicare “star rating” (consumer satisfaction rating).

[winodog]

There is a large price spread on the part G policies. Any advice to follow on choosing? I am ready to switch back to medicare with part G.

[catnipman]

when one signs up for an advantage plan, they sign over the financial benefits that they would have received from medicare Part A and instead medicare pays THAT money to the advantage plan ....

[catnipman]

looks like ya’ll did your research and made some smart choices!

[winodog]

If I switch back to medicare part a and b price would remain the same taken out of monthly SS check? Then they would deduct the price of the part G policy on top of that?

[catnipman]

If I switch back to medicare part a and b price would remain the same taken out of monthly SS check? Then they would deduct the price of the part G policy on top of that?

medicare advantage is assigned all benefits from Part A & Part B (meaning you still have to pay a Part B fee), plus some advantage plans have an additional monthly fee

for regular medicare, Part A is without charge ... Part B is still automatically subtracted out of your medicare payments, but one must privately pay for any optional medicare supplement (such as Plan G) and/or Part D (drug plan) ... however, it’s usually most convenient to get those payments automatically deducted from you bank account ...

so, your Part B payments remain the same if you switch back to regular medicare, plus whatever fees you privately pay for a standardized supplement (highly recommended) and a part D (drug plan) you optionally elect ...

standardized supplements are relatively easy to choose, as they are standardized to pay everything exactly the same way within a given plan type (e.g., Plan G) ... so, whatever standardized supplemental plan you decide you want (e.g., Plan G), you basically choose the provider in your state that is the cheapest for that standardized plan (assuming you have a choice) ... in colorado, for example, the cheapest provider for Plan F is AARP’s United Health Care partnership, meaning you have to join AARP ...

choosing a Plan D is a whole nother ball of wax, though (thank you very much George Bush, you piece of shite) ...

[winodog]

TY for the information.

[thinden]

thanx for all the info, catnipman

[StAnDeliver]

"York, Pa.-based WellSpan Health will no longer accept Humana Medicare Advantage and UnitedHealthcare-AARP Medicare Advantage plans starting Jan. 1. UnitedHealthcare group MA PPO and Humana employer PPO MA plans will still be accepted."

Good luck with that. Humana is exiting employer-based plans January 1, 2024. So they'll probably try to bait-and-switch those poor mopes onto their straight MA non-coverage, as explained in the very next graf:

"WakeMed cited a claims denial rate that is "3 to 4 times higher" with Humana compared to its other contracted MA plans."

The fact that Humana announced they were leaving employer plans waaay back in February of this year, means there is a fait accompli to rearrange the insurance industry next year, with Humana abandoning employer in order to meet anti-trust regs to take on more Tricare (probably acquiring Health Net) and also expanding their Tricare For Life Medicare-wraparound coverage. Be very concerned.

[StAnDeliver]

"I go to the doctor as little as possible. Not a one has assisted me with a medical problem in the past 20 years. For almost every single visit lately, the PA’s recommendation has been the drug Neurontin — no matter what the problem may be. I’ve seen what that drug can do. My late sister was on so much of that drug that I swear it destroyed her brain."

Neurontin is so in need of a class-action suit to bring it to an end, it boggles the mind.

In the next decade people will look back and regard it the way we regard thorazine dumped into nursing homes in the 70s and 80s.

[StAnDeliver]

"I expect TRICARE for Life to be the next target of the collectivists."

See #175. Those wheels were set into motion last February. The irony? The GOP will hide it in the military fat of the upcoming omnibus bill.

[PerConPat]

Thanks for the heads-up...

[coalminersson]

I just quit My wife is just into social security and she is a RE broker. I was a broker till recently. Never took a dome, left it in the company or gave it to her. Paid cash for business cars etc. My insurance is from my job in corrections. Left after a heart attack in 97. Best wishes

[coalminersson]

Thanx