St. Charles Health System, a large hospital system in central Oregon likely will not continue to participate in Medicare Advantage, reports KTVZ.com. The hospital system’s leaders are concerned about patient care in Medicare Advantage. People with Medicare who want to know they have access to the best hospitals, including access to cancer centers of excellence, should switch to traditional Medicare.
St. Charles is not alone; many hospital systems are not taking Medicare Advantage enrollees. St. Charles’ CEO says that the hospital system has considered dropping Medicare Advantage plans for some time because of mounting concerns. He reports that his hospital system is not alone. Hospital systems throughout the country are concerned about patient care in Medicare Advantage. The Mayo Clinic stopped taking Medicare Advantage enrollees at some sites last year.
In the CEO’s words: “The reality of Medicare Advantage in Central Oregon is that it just hasn’t lived up to the promise. A program intended to promote seamless and higher-quality care has instead become a fragmented patchwork of administrative delays, denials, and frustrations. The sicker you are, the more hurdles you and your care teams face. Our insurance partners need to do better, especially when nurses, physicians and other caregivers are reporting high levels of burnout and job dissatisfaction.”
The American Hospital Association (AHA), the trade association for most hospitals reports that it “is increasingly concerned about certain (Medicare Advantage) plan policies that restrict or delay patient access to care, which also add cost and burden to the health care system.” To make matters worse, it appears that some Medicare Advantage plans are engaged in fraud as well as inappropriate delays and denials of care and coverage.
St. Charles hospital executives see higher rates of denials of care in Medicare Advantage and long arduous processes for getting Medicare Advantage plans to approve medically necessary care. St. Charles health system is considering whether it will renew Medicare Advantage contracts with PacificSource, Humana, HealthNet and WellCare.
The bottom line: With traditional Medicare, your treating physicians call the shots, deciding what care is medically reasonable and necessary, and Medicare covers that care, without second-guessing and coming between you and your doctors. With Medicare Advantage, many insurance companies second guess treating physicians and deny care or delay care, endangering patient health.
The Office of the Inspector General has reported widespread and persistent inappropriate delays and denials of care and coverage in Medicare Advantage. But, the Centers for Medicare and Medicaid Services (CMS) has so far refused to identify the bad actors or sanction them appropriately, putting older adults and people with disabilities at serious risk.
Healthy patients in Medicare Advantage should be fine. But, even if you are healthy today, you could need complex care tomorrow and your insurance should cover that care. That’s why we have health insurance. In some Medicare Advantage plans, you might not get needed care in a timely manner, if at all, regardless of whether you need it.
Here’s more from Just Care:
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Medicare Advantage enrollees face higher likelihood of hospital care denials
- People in Medicare Advantage trade away access to care
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- The choice between traditional Medicare and Medicare Advantage: It’s a sham
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