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

[steve86]

I’d like to see that poster too. I mean, I can guess what it says... But still.

[minnesota_bound]

Here is what I got. I went thru Boomer Benefits earlier in July https://boomerbenefits.com and called an agent.

Anthem Blue Cross - Part G = $141.75
Mutual of Omaha - dentist = $31.82
Wellcare Part D = $8.30
Total = $181.87
Medicare Part A & B = $164.90
Grand Total = $347.30 a month.

Part B deductible = $226.00
Drug deductible = $505.00

There are 180 posts here. You may have to log in to read them:
https://www.early-retirement.org/forums/f38/supplement-medicare-plan-questions-118457.html

Here is a good review:
Medicare Advantage vs Medicare Supplement (MediGAP)
https://www.forbes.com/health/medicare/medicare-advantage-vs-medicare-supplement/

[Chickensoup]

I have had nothing but good luck with MA plan. What sort of horrible stories have you heard?

[Chickensoup]

Our state laws do not permit this

[Chickensoup]

Why?

[Chickensoup]

Jim Noble: Systemically, however, MA programs are causing catastrophic harm and they should be discontinued soon.

.....

What sort of catastrophic
harm?

Every one on our MA plan loves it.

[Vendome]

Funny

Many friends have been telling me how much Medicare was worth and once they entered MA system just how much was denied , even though MA says this or that is covered.

They asked how I deal with it and I said “Cash is king. I start laying down Benjamin’s”

[Chickensoup]

Sometimes one has to hit return after posting the link

[HartleyMBaldwin]

The sooner you get started, the better. Do lots of research into everything. Make spreadsheets to compare different plans. Talk to friends. Remember that insurance agents have their own interests ahead of yours.

I ended up going with a Medicare Part G supplement. My wife has a Medicare Advantage plan and has had no problems with it so far.

[GOPJ]

Funny...the hospital where I get my care,a very famous one,just started offering its own Medicare Advantage plan.

...the plot thickens

[Jane Long]

Jim Noble: Systemically, however, MA programs are causing catastrophic harm and they should be discontinued soon.

.....

What sort of catastrophic harm?

---

Ask Jim….that’s Jim Noble’s comment.

I pinged him, for you :)

[RushIsMyTeddyBear]

Bkmrk.

[MayflowerMadam]

The worst was my friend in her late 70s who broke her neck (didn’t kill her). Surgeon’s told her she HAD to have surgery. TOTB in her Advantage denied surgery. Told her she had to stay in bed for three months until she had healed.

Other stories, but not as drastic.

[Ann Archy]

I have one of those plans.

[steve86]

“but I doubt Medicaid is more than the dime on the dollar allowed by Medicare......”

It’s usually less. I hear that frequently.

[Jim Noble]

All of the hospital adjacent entrepreneurial inventions exist to strip-mine the huge pool of money created by Federal, State, and local governments + employers, the purpose of which is to care for sick people.

[telescope115]

I see a lot of those commercials. Now William Devane, who’s been hawking gold, is on the MA bandwagon. I’m so glad this is coming out now, we have looked at those plans, and even our insurance agent told us that we are better off with Medicare and a supplemental, which we’ve had since we both retired.
My first year of retirement, I had my liver transplant surgery, and by the time all the bills were tallied, Medicare and my supplemental paid virtually 100 percent.

All I pay for is my medication co-pay. Sure, our premiums have gone up, but what hasn’t?

[steve86]

“BCBS is going up 60% 1/1/2024, $406.00’

Sorry to hear that, must be a state or regional thing. I just paid my Dec-Feb BCBS Part F premiums (this thread reminded me it was due!) for $339 (total). The per month cost seems to have gone down a bit from last year. You still have a few days to shop around, don’t you?

[telescope115]

They’re hard to figure. I have Part D but it’s next to worthless on some drugs.

*****

Agree. I have A,B, and D, and some of my meds are generic. Tier 5 drugs are cost prohibitive for me.
I have supplemental insurance, but it doesn’t cover them.

[steve86]

” He ended up in a non-network hospital after having a heart attack. “

At least part of it has to be covered if it was emergency surgery; if not emergency he should have been transported to an in-network hospital.