Rural hospitals are a critical source of health care for millions of Americans. But, Medicare Advantage plans are refusing to pay them Medicare rates and denying coverage for a large portion of services they provide. Corporate health insurers offering Medicare Advantage plans are putting the survival of rural hospitals at risk, reports Axios.
At more people enroll in Medicare Advantage, more rural hospitals are closing or feeling the threat of closure. These hospitals don’t have the negotiating power of larger hospitals to ensure Medicare Advantage plans pay them adequately and appropriately. (And, even some larger hospital systems are cancelling their Medicare Advantage contracts because of inadequate payments and patient care concerns.) Traditional Medicare is a far better payer that they have relied on.
Still, rural Americans are enrolling in Medicare Advantage, likely unaware of the risks to their health and well-being, particularly if they develop a complex and costly condition. Medicare Advantage marketing and sales agents highlight the “free” benefits in Medicare Advantage, without describing the dangers–inadequate networks, inappropriate delays and denials of care and coverage, and more.
The biggest dangers in Medicare Advantage come when you most need health care. You can face long waits for approval of care. And, too often, Medicare Advantage plans wrongfully refuse to pay for care that traditional Medicare covers. Hundreds, if not thousands, of Medicare Advantage plans deny care and coverage inappropriately.
People don’t appreciate that it can be hard to come by a good oncologist in Medicare Advantage if you’re diagnosed with cancer. Mental health benefits can also be hard to get. And, Medicare Advantage plans have been found to deny people rehab therapy post hip and knee replacements or to cover far less therapy than people need.
Some Medicare Advantage plans might actually be doing right by their members. But, if they are, no one is disclosing which are the good ones and which are the bad ones. Imagine buying a car without knowing whether the engine is likely to fail or buying a house without being able to inspect for termites. Tens of thousands of older adults and people with disabilities end up with serious health complications or worse because their Medicare Advantage plans refused to cover the care they needed.
Now, hundreds of rural hospitals are at risk of closure, in part because Medicare Advantage plans are not paying them as they should. Corporate insurers such as UnitedHealth and Cigna, which both cover care for people in Medicare Advantage and in the employer market, profit from denying care and coverage. Because the Centers for Medicare and Medicaid Services lacks the resources to oversee them properly, they can get away with these denials with impunity.
Let your representatives in Congress know that you will hold them accountable if they don’t protect Medicare Advantage members and their hospitals from the bad actors in Medicare Advantage. At the very least, the government should be identifying the Medicare Advantage plans with high rates of delays and denials rather than giving some of them four and five star ratings.
Here’s more from Just Care:
- Rural hospitals need government help to survive
- People living in rural communities disenroll from Medicare Advantage at a high rate
- Mental health telemedicine growing in rural areas
- Hospitals find a lot wrong with Medicare Advantage
- Hospitals dropping Medicare Advantage because of concerns with patient care
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