JustCare

Category: Your Coverage Options

  • Three big Medicare access to care issues put vulnerable people at serious risk

    Three big Medicare access to care issues put vulnerable people at serious risk

    The Centers for Medicare and Medicaid Services has issued its annual Medicare Advantage (MA) proposed rate notice for 2025 and is seeking comments before it finalizes the rate. It is trying to combat tens of billions of dollars in annual overpayments to Medicare Advantage plans. Right now, they result in about $25 billion a year in higher premiums for Medicare enrollees. If not terminated, these overpayments will, over time, destroy Medicare, making it unaffordable for the older adults and people with disabilities who rely on it for their medical care.

    What are the big issues with Medicare today?

    Traditional Medicare, which gives people easy access to care from physicians and hospitals across the US, is not an option for people with low incomes because it lacks an out-of-pocket cap, and Medigap is unaffordable or unavailable to them. MA plans are good while you’re healthy, but that’s not why we have health insurance. When you develop cancer and other costly conditions, MA plans have a powerful financial incentive to stint on care and few constraints since they face little accountability for their bad acts. Non-standardized administrative processes, including claims processing and prior authorization protocols, mean inappropriate delays and denials, ineffective CMS oversight and no way to protect people, particularly people with costly conditions, from bad actor plans.

    People cannot make meaningful Medicare choices. Information is misleading and inadequate to keep people from joining MA plans that impose inappropriate barriers to care and endanger their health when they get sick. CMS tells them they’ll get the same benefits in Medicare Advantage as Traditional Medicare. But, it’s not true. Some plans have high denial rates, ghost networks, inappropriate prior authorization obstacles, high mortality rates. People can’t avoid them. MA plans compete to maximize profits not to promote high value care for those who most need it. CMS can only protect them if there is significantly more MA standardization. Greater standardization of out-of-pocket costs and claims processing would help promote meaningful choice and appropriate coverage. CMS also needs resources to enable appropriate oversight and enforcement.

    Non-standardized Medicare Advantage administrative processes enable inappropriate care denials: So long as CMS cannot protect vulnerable individuals from MA plans that impose harmful barriers to care, TM needs to be a meaningful choice. Until Congress acts, CMS should use CMMI, its innovation center, to test a Traditional Medicare model with low out-of-pocket costs and an out-of-pocket limit that is on a more level playing field with Medicare Advantage. If TM is not on a level playing field with Medicare Advantage, Traditional Medicare will disappear, there will be less choice and higher costs for Medicare Advantage enrollees, the vulnerable will be most at risk. To help protect vulnerable MA enrollees, CMS should require MA plans to use a centralized independent agency to do claims processing and prior authorization so that plans compete to deliver better managed and coordinated care, not to avoid covering care for people with complex conditions.

    Notwithstanding CMS’ efforts to address some of the problems with prior authorization and inappropriate delays and denials of care, proprietary and non-standardized claims processing and prior authorization rules mean inappropriate delays and denials, ineffective CMS oversight and no way to protect people, particularly people with costly conditions, from bad actor plans. Without an independent intermediary to process claims in a timely and standardized manner, vulnerable enrollees have a good chance of not getting the medically necessary care to which they are entitled; and, the bad actor MA plans will go undetected, to the detriment of their most vulnerable enrollees.

    Here’s more from Just Care:

  • With Medicare Advantage, less for you is always more for insurers

    With Medicare Advantage, less for you is always more for insurers

    David Wainer reports for the Wall Street Journal that people in Medicare Advantage plans–coverage through corporate health insurers–are likely to see fewer extra benefits next year. That’s no surprise, nor will it be a surprise for Wall Street when everyone enrolled in Medicare Advantage faces much higher out-of-pocket costs than they do today and no longer have government-administered traditional Medicare as an option. If the administration and Congress do not swiftly rein in tens of billions in annual overpayments to insurers offering Medicare Advantage, the only question is when people will appreciate that Medicare Advantage is a helluva disadvantage.

    About 32 million people are  now enrolled in a Medicare Advantage plan, just under half the Medicare population. People are swayed by the ads offering “dental” benefits and free gym memberships and the seemingly trustworthy insurance agents steering them towards Medicare Advantage. Older adults and people with disabilities also can’t afford or don’t want to spend money on supplemental coverage in traditional Medicare that picks up most out-of-pocket costs, when they would like to believe they won’t be needing much health care. Since at any given time the vast majority of people don’t need a lot of health care, it has yet to sink in for them that insurers could take advantage of them if they are in a Medicare Advantage plan.

    Wainer says that insurers now need to address greater health care spending and lower government payments to appease Wall Street and deliver handsome shareholder returns. What’s concerning is that the bad actor Medicare Advantage plans–and we don’t know how many or which ones those are, but they appear to be numerous–are still raking in billions of dollars in profits from Medicare Advantage that they seem not prepared to spend on their enrollees’ medically necessary care. What kind of a health care coverage model is that?

    Wainer says that “if the current trends continue, plans will have to be more cautious in their offerings going forward.” Really? Truth is that people need to be more cautious about enrolling in a Medicare Advantage plan going forward. Medicare Advantage plan offerings in some, if not most, cases are concerning for people who need care–including restricted access to high quality doctors and hospitals, administrative hurdles and delays getting urgent care, inappropriate denials of care and high out-of-pocket costs.

    Even with tens of billions in annual overpayments, Medicare Advantage plans delay and deny care inappropriately. And, many restrict access to high quality providers. Some have such high mortality rates that one group of academics found that the government could save tens of thousands of lives a year if it ended contracts with those Medicare Advantage plans.

    If all goes well, people will start to see that Medicare Advantage is no free lunch when they most need care. In fact, it can easily cost people twice as much as what they’d spend on care in Traditional Medicare with supplemental coverage, with huge delays and obstacles to getting care.

    Wainer is correct that threats from insurers about cutting extra benefits in Medicare Advantage are designed to pressure the Biden administration to continue to overpay them. The administration is currently deciding Medicare Advantage rates for 2025. Beware: If CMS steers away from its current course of reining in Medicare Advantage overpayments, you will pay ever higher Medicare premiums and, before long, face signficantly higher Medicare costs.

    Here’s more from Just Care:

  • Medicare Advantage cannot rely exclusively on AI to deny coverage

    Medicare Advantage cannot rely exclusively on AI to deny coverage

    For some time now, UnitedHealth and other health insurance companies are reported to have been using artificial intelligence tools to broadly deny coverage in certain instances for people enrolled in Medicare Advantage plans. Insurers claim that the tools simply help them determine whether to deny a service. Use of these tools appears to have led to large numbers of inappropriate denials of care for Medicare Advantage enrollees, and the Biden administration is now stepping in reports SkilledNursingNews.

    The Centers for Medicare & Medicaid Services (CMS), which oversees Medicare, is restricting insurers’ ability to use AI tools to deny claims for Medicare Advantage enrollees. It issued an FAQ to insurers offering Medicare Advantage plans to ensure insurers understand that Medicare Advantage plans cannot deny care without considering individual patient’s needs.

    The FAQ explains how insurers can use algorithms and AI in Medicare Advantage. And, it clarifies coverage requirements for post-acute care to help ensure patients aren’t wrongly denied critical care. Insurers can use prior authorization, but not in an emergency or urgently needed care situations or for out-of-network services they cover.

    While insurers can use AI in determining whether to cover a service, they are responsible for making sure that the AI complies with the Medicare coverage rules. And, they can’t rely exclusively on AI. Insurers offering MA must consider each individual enrollee’s situation, including the enrollee’s medical history and treating physician’s recommendation, in deciding whether care is medically necessary. And, before an insurer ends services for MA enrollees, their individual conditions must be reevaluated.

    Furthermore, insurers must publicly release their coverage criteria on a website and cannot change it as they please, according to CMS. And, if your doctor says you need post-acute care in a rehab facility, your health insurer cannot second-guess that decision so long as you meet Medicare coverage criteria for such care.

    If an insurer still denies coverage, it bears the burden of proof on appeal that care is not medically necessary through a detailed explanation. And, a provider with expertise in that care must issue the denial.

    Here’s more from Just Care:

  • Why doesn’t the federal government regulate assisted living facilities?

    Why doesn’t the federal government regulate assisted living facilities?

    The Senate Special Committee on Aging is looking into quality and cost issues in Assisted Living Facilities, reports Jordan Rau for KFF Health News. But, the federal government does not regulate these facilities, even though it pays for them in some cases for people with Medicaid. It’s not likely that Congress will enact legislation to regulate them.

    More than 800,000 Americans live in an Assisted Living Facility (ALF) today. ALF residents include people who can’t bathe themselves or feed themselves. People with dementia. People unable to walk unassisted.

    The cost of living in an ALF is prohibitive for most Americans, typically around $4,500 a month, way more than the typical Social Security check. In cases where residents need substantial amounts of care, the cost can be $10,000 a month. Some facilities impose additional charges for basic services. One ALF charges $93 a month simply to order medications for its residents.

    Medicare does not cover ALFs.  And, only 20 percent of ALFs accept Medicaid patients. But, one argument for federal oversight of ALFs is that the federal government spends more than $10 billion dollars on these ALF residents.

    What services do people get for their money in an ALF? They should get assistance with activities of daily living. However, staffing levels in ALFs are too often low and workers can be poorly trained.

    Today, it’s up to each state to regulate ALFs. Given that few states have the will, the skill, the power and the resources to oversee these facilities, many patients in these facilities are not getting quality care.

    Monitoring of ALFs is inconsistent across states. And, data is hard to secure if you want to understand how different ALFs operate. Federal oversight is needed to protect ALF residents across the US.

    Richard Molloy, who runs the Long Term Care Community Coalition, explains that “too many [long term care facilities] take in or retain residents for whom they are unable to provide safe care and dignified living conditions. Too many residents and families are at risk for financial exploitation and even fraud.”

    Here’s more from Just Care:

  • Choose your hospice provider carefully

    Choose your hospice provider carefully

    Hospice care has grown in popularity for people with terminal conditions who seek comfort care rather than curative treatment. But, now, more than ever, you need to choose your hospice provider carefully. Ava Kofman continues to write for Pro Publica on how profiteers have taken over hospice in the US, at huge financial cost to the Medicare program and huge risk to patients at the end of life.

    As a result in significant part of Kofman’s earlier reporting, described in this Just Care post, the Centers for Medicare and Medicaid Services (CMS) conducted more hospice inspections. But, CMS continues to certify new hospices, even in California, where the state has banned new hospice licenses because of mounting hospice fraud.

    It appears that CMS does not have the ability or desire to close down hospices engaging in fraud. After visits to 7,000 hospices, CMS stopped just 46 of them from billing the government for their services. The travesty: The 46 hospices were nonoperational.

    CMS claims that it’s up to the states to stop the proliferation of hospices. CMS appears to be unwilling or unable to prevent even fraudulent or unneeded hospices from receiving certifications to deliver the hospice benefit to people with Medicare.

    Arizona, California, Nevada and Texas have seen a huge spike in the number of its hospice providers. CMS showed marginal concern at best about fraudulent bills from these hospices and the lack of need for additional hospices in these states. CMS said it would look at their bills more closely.

    California attempted to put a moratorium on new hospices in its state, with little success. Its auditors detected “a large-scale, targeted effort to defraud Medicare.” Hospice providers charged Medicare for patients who were not terminally ill and sometimes for patients who were fictitious.

    Notwithstanding California’s good oversight, CMS is allowing these hospice providers to bill Medicare for their “services.” CMS claims to need “evidence of sanctions” against a hospice in order to block a hospice from the Medicare program.

    In California, people enrolled in hospice fraudulently—people who are not terminally ill or who do not want hospice—are reportedly at risk of not getting needed care. Medicare covers hospice services only for patients who agree not to receive curative care for their conditions. That said, they should be able to get care for any condition unrelated to a terminal condition. Moreover, they are also always able to opt out of hospice to get curative care.

    In one case, a nursing home resident with dementia was fraudulently enrolled in hospice by a doctor she did not know. Medicare paid the hospice $7,500. But, the patient lost her ability to have her pacemaker checked and to receive physical therapy. CMS is now investigating.

    Here’s more from Just Care:

  • Take advantage of the Medicare Advantage Open Enrollment period

    Take advantage of the Medicare Advantage Open Enrollment period

    If you’re in a Medicare Advantage plan, you should seriously consider taking advantage of the Medicare Advantage open enrollment period between January 1 and March 31 that allows you to switch to Traditional Medicare or to a different Medicare Advantage plan. This opportunity for to switch out of your Medicare Advantage plan is an important consumer protection. Medicare Advantage plans could have changed their provider networks or drug coverage between the fall Medicare Advantage Open Enrollment Period and now.

    I’ve written at length about all the reasons to avoid enrolling in a Medicare Advantage plan, especially if you have Medicaid or can afford the supplemental coverage that you need in Traditional Medicare to limit your out-of-pocket costs. Upfront costs in Medicare Advantage are less than those in Traditional Medicare with supplemental coverage. But, if you get sick and need care–the reason you have health insurance–your out-of-pocket costs are likely to be a lot higher in Medicare Advantage than in Traditional Medicare.

    Moreover, access to care is much simpler in Traditional Medicare than in Medicare Advantage. In Traditional Medicare, your treating physicians decide the care you need without an insurance company second-guessing your doctor and profiting every time it denies you care. And, there are no prior authorization requirements, nor is there a restricted network. You are covered for care from the vast majority of physicians and hospitals in the US. With supplemental coverage, your costs are predictable and often very little.

    Medicare Advantage HMOs restrict your coverage to the doctors and hospitals in their networks. You can go out of network for some coverage only if you’re in a PPO. But, even in a PPO, coverage tends to be limited and unpredictable. Driving your costs up further and/or endangering your health, Medicare Advantage plans impose prior authorization requirements before they will cover your care. And, they inappropriately deny care, particularly to people with costly conditions–people needing rehab care, people with cancer and people with other complex care needs.

    The Centers for Medicare and Medicaid Services, which oversees Medicare, should be protecting you from bad actor Medicare Advantage plans, but it cannot. It does not have the capability, the money, or the power to oversee the more than 4,000 Medicare Advantage plans, much less to hold them to account for their bad acts.

    You should also bear in mind that you can’t count on the providers in Medicare Advantage directories actually being willing to see you. Multiple reports reveal “ghost” networks in some Medicare Advantage plans. As well, I’ve reported many times in Just Care on hospitals terminating their Medicare Advantage contracts, leaving Medicare Advantage plan enrollees scrambling to find alternative care or forced to drive long distances for inpatient services. Memorial Hermann in Houston, Texas is the most recent hospital system to do so, ending its Medicare Advantage contract with Humana.

    Here’s more from Just Care:

  • Critical home care is no longer affordable for most people and too often not available

    Critical home care is no longer affordable for most people and too often not available

    Caring for an older person with multiple needs can take a toll physically, emotionally and financially. Reed Abelson reports for The New York Times on how reliable home care is hard to come by and not affordable over the long-term.

    Frank Lee, the husband of one woman with dementia, was tending to his wife morning, noon and night. He ended up putting her in a respite program at an assisted living facility so he could take a short break. While he was away, she fractured her sacrum. Mr. Lee was at a loss to find home health aides he could trust, the plight of many older couples.

    Eight million older adults suffer from dementia or need help with at least two activities of daily living, such as bathing and toileting. Only a small fraction of them–one million–have paid help outside a nursing home. Three million have no help.

    Our federal government does little to help people who need home health aides. Medicare only covers very limited home health health care and, then, only for people who are homebound and who need skilled nursing on an intermittent basis or skilled therapy. People with dementia don’t usually fit these criteria. If you don’t have Medicaid, you are generally out of luck in terms of government assistance and, even with Medicaid, there are often waitlists for home care.

    Most older adults are cared for by family, not professionals. They cannot afford $27 an hour, the going rate for a home care aide. Paying for fulltime home care usually means expenses of tens of thousands of dollars a year. Usually it is the older adult’s spouse or daughter  who takes on the role of caregiver.

    People who can afford to pay for a caregiver often cannot find one with the skills to take care of their loved ones. They are often forced to hire untrained caregivers. Paid caregivers in the US rarely earn a living wage; they often can’t count on fulltime work. And, they tend not to get health insurance benefits. It’s no wonder that there is a shortage of paid caregivers; they can get better jobs for the money.

    What to do? Plan ahead. Talk to your loved ones about likely long-term care needs. Even if you have limited resources, it is better to be prepared. Most people do not have these conversations. Families are often unprepared. Many families cannot save enough to offset the cost of long-term care. But, if you plan ahead, you could qualify for Medicaid.

    Keep in mind that long-term care needs can be extensive. Sometimes, two people are needed just to move someone from one place to another. Without assistance, simple tasks become huge burdens.

    Mr. Lee wonders “What’s the end game look like?” Is it right that he should watch his wife, who is already severely demented and unable to take care of herself or speak, deteriorate further? “As she disintegrates, I disintegrate.” When people are terminally ill–six months or less of life–Medicare covers hospice care, which covers some home care. But, good luck getting it if you’re in a Medicare Advantage plan. And, even in traditional Medicare, finding an agency that will provide hospice care can sometimes be challenging.

    Here’s more from Just Care:
  • Why health insurers deny necessary care and get away with it

    Why health insurers deny necessary care and get away with it

    If you’re wondering why insurance companies deny necessary care and get away with it, it’s not only that the insurers are pulling all the strings and have become too big to fail. It’s that different doctors often have different opinions about what is medically necessary. A new report from the Center for Improving Value in Health Care focuses on the health care that people get that the Center says is not medically necessary, driving up health care spending, reports Markian Hawryluk for KFF Health News.

    The amount spent on unnecessary care or “low value” care in Colorado, as reported–$134 million in 2022–seems relatively small. The Center says it is the tip of the iceberg. But who is to judge what is low-value care? The health insurance companies should not be the judge when they profit from denying care.

    There is tremendous risk in turning authority over treatment decisions from physicians to insurance companies, as Medicare has done through the Medicare Advantage program. Where is the value in handing buckets of money to health insurance corporations who can deny coverage for low, medium and high value care without justification, in secret, largely with impunity, in order to maximize profits?

    And, we continue to hear horror stories of the health insurers denying needed care through AI algorithms and staff physicians who earn bonuses when they don’t refer patients for costly specialty care. Why would we trust the insurance companies and their staff to get coverage decisions right when they have no understanding of particular patient conditions and an incentive to deny care? Read this post on how UnitedHealth is using AI to deny rehab care to vulnerable older adults without regard to their particular conditions and weep.

    Of course, there is no perfect payment system. The Center for Improving Value in Health Care appears to like the idea of giving insurers buckets of money to cover care. But, rather than giving insurers the discretion over these treatments, isn’t the fix to have national policies, publicly vetted, about what is covered and not covered? If opiates, antipsychotics and screenings for Vitamin D deficiency are really unnecessary in most cases, why are insurers covering them?

    A capitated payment system–one in which the insurers are handed money upfront to “manage” care–simply changes the incentives, disregarding physician opinions, working against patients, and rewarding insurance companies for giving less care or for denying care inappropriately. And, corporate health insurers operate in a proprietary or secret system. Researchers can’t even learn whether what insurers are doing when they deny care is endangering people’s lives or helping them. How does that add value?

    What’s crystal clear is that if we are going to improve the health care system, we need to collect and review patient data. We need to know what is working and not working. We need to know in real-time what’s happening to protect people from insurance companies that put their profits first. And, we need to be doing what other wealthy nations do: Dictating all the terms of coverage, removing discretion over coverage decisions from insurance companies, so that people can count on getting the care they need without delay and are not forced to gamble with their health.

    Here’s more from Just Care:

  • Seven questions you should be asking this Medicare Open Enrollment period

    Seven questions you should be asking this Medicare Open Enrollment period

    During this Medicare Open Enrollment period, ask yourself these seven questions. And, please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP (State Health Insurance assistance Program) for free, unbiased advice on any of your Medicare questions.

    1. Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. In traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all doctors and hospitals in the United States with no incentive to stint on your care. In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often second-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care. Regardless of whether you stay in traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.
    2. Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to steer you away from traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare. For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a State Health Insurance Assistance Program (SHIP).
    3. Q. Why can’t I rely on my friends or the government’s star-rating system to pick a good Medicare Advantage plan? Unlike traditional Medicare, which gives you easy access to the physicians and hospitals you use from everywhere in the US and allows for continuity of care, you can’t count on a Medicare Advantage plan to cover your care from the health care providers listed in their network or to cover the medically necessary care that traditional Medicare covers. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their health care. The government’s five-star rating system does not consider that some Medicare Advantage plans engage in widespread inappropriate delays and denials of care, and other Medicare Advantage plans engage in different bad acts that can endanger your health. So, while you should never sign up for a Medicare Advantage plan with a one, two or three-star rating, Medicare Advantage plans with four and five-star ratings can have very high denial and delay rates.
    4. Q. If I’m enrolled in a Medicare Advantage plan, can I count on seeing the physicians listed in the network and lower costs? Unfortunately, provider networks in Medicare Advantage plans can change at any time and your out-of-pocket costs can be as high as $8,300 this year for in-network care alone. You can study the MA plan literature, and you can know your total out-of-pocket costs for in-network care. But, you cannot know whether the MA plan will refuse to cover the care you need or delay needed care for an extended period. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care.
    5. Q. Doesn’t the government make sure that Medicare Advantage plans deliver the same benefits as traditional Medicare? No. The government cannot protect you from Medicare Advantage bad actors. The insurers offering Medicare Advantage plans can decide you don’t need care when you clearly do, and there’s no one stopping them; they are largely unaccountable for their bad acts. In the last few years there have been multiple government and independent reports on insurance company bad acts in Medicare Advantage plans.
    6. Q. If I join a Medicare Advantage plan, can I disenroll and switch to traditional Medicare? You can switch to traditional Medicare each annual open enrollment period. However, depending upon your situation, where you live, your income, your age and more, you might not be able to get supplemental coverage to pick up your out-of-pocket costs and protect you from high costs. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage.
    7. Q. If I have traditional Medicare and Medicaid, what should I do? If you have both Medicare and Medicaid, traditional Medicare covers virtually all your out-of-pocket costs. You will get much easier access to physicians and inpatient services in traditional Medicare than in a Medicare Advantage plan if you need costly health care services or have a complex condition.

    For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a State Health Insurance Assistance Program (SHIP).

    Here’s more from Just Care:

  • Medicare Advantage plans are not addressing loneliness among their enrollees

    Medicare Advantage plans are not addressing loneliness among their enrollees

    Loneliness is prevalent amount older adults in Medicare Advantage plans, reports Alexa Mikhail for Fortune. Most older adults no longer work and have few outlets for social interaction. The government is not addressing their lack of social stimulation. Their Medicare Advantage plans, government health plans administered by corporate health insurers, which are paid to manage their enrollees’ health, should be helping to address their enrollees’ loneliness.

    A survey of 28,000 older adults in Medicare Advantage plans finds that more than half of them (three  in five) are lonely or extremely lonely. Family are often not near by. Friends are often not around. As a rule, their Medicare Advantage plans do not help them. Consequently, older adults who suffer from loneliness are at greater risk for a range of health issues, including dementia, depression and anxiety.

    What can isolated adults do in an emergency? One in five older adults have no one to turn to in an emergency. Two in five struggle to find social support. Medicare Advantage plans do not make it their business to foster social interaction among their enrollees, even though it’s an important way to promote their well-being.

    Many older adults struggle mentally and physically as a result of social isolation. They need help taking their medicines and remodeling their homes, but they can’t get help. They don’t have easy and safe access to a bathroom, shower, kitchen and bedroom. They can’t get to their doctors’ appointments. It’s not clear that any Medicare Advantage plans are helping to ensure these basic needs are met or even to minimize enrollees’ risk of falling, even though these corporate health plans are receiving some $140 billion in overpayments each year from the government.

    Half of older adults have annual incomes under $30,000 and deteriorating health. Loneliness means that they are as much as three times more likely to end up in an emergency room than people who have family or other social companions around to help.

    If Medicare Advantage plans were putting enrollees’ needs ahead of their profits, they would be promoting social engagement among their enrollees and otherwise spending money on their enrollees in meaningful ways.

    Here’s more from Just Care: