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Coronavirus: Medicare Advantage plans doing little to ensure their members get needed care

a href="">Artsiom Horsky
Written by Diane Archer

In the face of the novel coronavirus pandemic, the Centers for Medicare and Medicaid Services (CMS) has mandated that Medicare Advantage plans–corporate health plans that offer Medicare benefits–remove certain restrictions on covered care. Unfortunately, it does not appear that these private plans are letting their members know. Based on the information available on their web sites, they are doing precious little to ensure their members get needed care, endangering the lives of hundreds of thousands of older adults and people with disabilities.

CMS is requiring Medicare Advantage plans to cover coronavirus-related treatment from out-of-network providers in Medicare-participating facilities at the same cost as at in-network facilities. And, people do not need a referral to be covered. Virtually all hospitals in the US are Medicare-participating facilities.

Shockingly, UnitedHealthcare, Humana and Aetna  coronavirus web pages do not mention these expanded protections for people in Medicare Advantage plans needing coronavirus treatment. In fact, they are largely silent on coverage for treatment. UnitedHealthcare, Humana and Aetna combined cover half of all Medicare Advantage enrollees.

It appears that Medicare Advantage plans are also keeping all cost-sharing and prior authorization requirements in place for people needing coronavirus treatment. CMS issued guidance allowing them to waive these requirements, but not mandating that they do so.

Because out-of-pocket costs can be very high for people needing hospital care, one in four people with corporate health insurance skip treatment. Of course, deductibles, coinsurance and other barriers to care in Medicare Advantage plans will keep thousands, if not tens of thousands, of older adults and people with disabilities from getting needed treatment. But, they presumably will help Medicare Advantage plans’ bottom lines.

A new Kaiser Family Foundation paper shows that people in Medicare Advantage plans who are hospitalized for seven or more days will spend more out of pocket for their care than they would had they been in traditional Medicare. Nine in ten people in traditional Medicare will spend nothing or close to nothing because they have supplemental coverage through Medigap, Medicaid or a former employer, which pays for all or virtually all out-of-pocket costs.

The six million people in traditional Medicare who do not have supplemental coverage that picks up the cost of the Part A deductible must pay $1,408 out of pocket if they are hospitalized. After that, they pay nothing for the next 60 days of hospitalization. For most people in Medicare Advantage plans, the average out-of-pocket cost is $1,762 for a seven-day hospital stay and $2,039 for a ten-day stay. Hospitalizations related to treatment for Covid-19, the disease caused by the coronavirus, can be far longer than ten days.

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