Posted on 11/24/2023 10:47:42 AM PST by 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
“I just wish they’d give us the $ instead in something like the form of an HSA type card so I could continue to do WTF I want, when and where I want.”
A supplement plan is the closest thing there is to that. You can go to any doctor who takes Medicare (98% of them according to Medicare) and no referral is needed to see a specialist.
Talk to a SHIP (State Health Insurance Program) representative from your state.
Thank you. I didn’t see.
Please hep me understand the math on these zero premium medicare advantage plans.
How can an insurance “spread the risk” among a large universe of policy holders paying zero premiums, yet getting dr, hospital, labs, Rx, dental & vision ++ m
Where’s the money coming from to pay for all this if not the policy owners???
No I had United Health Care but was not yet medicare eligible. I have had numerous procedures since on my PPO. I’m 77 next week
was telling gloryblaze about the cost of surgery 2002.
4am - Thanks - good find bump!
It’s because he gets lifetime commissions selling the supplements. Advantage pays $25/mo to the servicing Agt until he loses the business.... ymmv
Not so, still going strong, but closed to anyone not eligible by 1/1/20, those eligible are grandfathered. Plan G same coverage except for a $240 annual deductible in 2024... ymmv
that’s what i meant, it’s closed...
“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 ...
“I’m on Medicare A & B. Provider is Kaiser.”
you’re confused ... those two things are independent and unrelated: you either have one or the other. Kaiser provides so-called Advantage Plans which completely substitute for Medicare A & B ... with kaiser, your ONLY medical provider is essentially Kaiser themselves ... with medicare A&B, almost ALL other medical providers accept Medicare payment ...
You can get UIM insurance that covers your vehicle in Texas. In Oklahoma it only covers medical payments.
Sadly, before obamacare, if you were self-employed and wanted to move to another state you had to go through underwriting again. You might not be accepted but if you were it would surely cost more.
Divide and conquer once more.
United Healthcare-AARP- whoda thunk it?
I have Cigna and will keep it for its out-of-country coverage.
Thank you for posting this.
I am currently going through the placement of a family member in a Rehab and Long Term Care Facility that was hospitalized last week with a severe stroke.
I have POA, so the work of sorting this out falls on me.
United Healthcare is taboo. 9nly the worst of the worst nursing homes accept it.
My family member has Humana. It’s a little better than United, but still rejected by many nursing homes.
I spoke with a really good care facility admissions director yesterday that I worked with previously. He told me they didn’t accept Humana.
I asked if I should change her plan to another since we are in the change window until December 7th. He didn’t give me an answer.
I personally stayed with Medicare.
What I am seeing is an expansion of the NC state Medicaid program December 1, 2023 to rescue people as the NC state employees have used Humana and are very upset.
It’s a mess and about to collapse. Thank you George Bush and Obama for this catastrophe.
I agree. MA plans are closing hospitals. They screw the hospitals who are now hurting and refusing to accept the MA plans and thus denying patients treatment.
Many or possibly most nursing homes refuse to admit patients with United Healthcare.
Mr sneakers and I were fully expecting to get on an Advantage Plan upon retirement. However, as were approaching retirement, we started doing our research. OMG, there is so much misinformation out there! We decided to stay on original Medicare and add a supplement. We both chose supplement Plan N. It has all of the same benefits as Plan F or Plan G. The only difference is that Plan N does not cover excess charges - which are outlawed in Pennsylvania where we live, and there are co-pays for doctor visits ($20 or less) and a $50 copay if you go to the emergency room and are not admitted. We live in a zip code in Western Pa where the monthly premiums are low. I pay $76 a month and my husband pays $82 a month. Also, the plan N premiums go up more slowly every year. I do understand that, in other parts of the country, the monthly premiums can be a lot higher. In the end, we are both very happy with our choice. Plans F G and N are all good plans and cover the same things.
Thank you for sharing this
OK, I have United Healthcare Medicare Advantage Plan at age 67. No major health problems. Just getting spooked hearing all the horror stories. Are you still working? I am wanting to still work. Don’t have enough to do.
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