Most Republicans and Democrats in Congress appear to agree that all too often Medicare Advantage isn’t working well. As a result of inappropriate prior authorization policies, inadequate provider networks, wrongful delays and denials of care and coverage, a defective payment system and more, millions of people in Medicare Advantage and the physicians and hospitals treating them are at risk. Yet, David Schweikert, a House Republican from Arizona, has introduced a bill in Congress that would give the Centers for Medicare and Medicaid Services (CMS) authority to enroll people automatically in Medicare Advantage when they turn 65, reports Allison Bell for ThinkAdvisor.
The bill falls under the control of the House Ways and Means Committee and the House Energy and Commerce Committee. So far, it has no co-sponsors. But, if it takes off, the consequences could be deadly for millions of our parents and grandparents.
Today, almost everyone enrolling in Medicare at 65 is automatically enrolled in traditional Medicare. Traditional Medicare assures them access to care from virtually all hospitals and physicians in the US without the hassles of prior authorization and inappropriate delays and denials of care. The data show that a large cohort of people in Medicare Advantage plans who need costly services face obstacles to care they don’t face in traditional Medicare.
So, if the Schweikert bill were to become law, people could end up locked into a Medicare HMO that denies them the health care services to which they are entitled under Medicare. They could end up losing continuity of care from their treating physicians. Their assigned MA plan could deny them needed care. They could die needlessly, as tens of thousands of people in the worst-performing Medicare Advantage plans do every year.
Yes, people would have the right to switch out of these plans during some initial period of time after enrollment. But, it’s easy to imagine that a lot of vulnerable people will have no clue what has happened to them until it’s too late for them to disenroll. More likely, they would need to find new doctors and would face inappropriate delays and denials of care when they most needed it, as is too often the case today.
The Schweikert bill helps the insurers offering MA plans, putting more profits in their pockets. It would likely give them them the opportunity to game the Medicare Advantage program further. As written, CMS would enroll people in the least expensive MA plans, making it easier for insurers to know how to design those plans to their benefit.
The bill is under the jurisdiction of the House Ways and Means Committee and the House Energy and Commerce Committee. As of now, it has no co-sponsors.
Here’s more from Just Care:
- The wrong choice of Medicare Advantage plan could kill you
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Medicare Advantage inappropriate denials of care abound
- Medicare Advantage networks can be narrow and harmful
- What happens when Medicare Advantage overpayments end?
