Jakob Emerson reports for BeckersHospital on the plight of hospitals dealing with Medicare Advantage plans. The insurers offering Medicare Advantage plans often try to maximize profits by denying payments to hospitals inappropriately. Or, they refuse to pay for patient inpatient stays and downgrade them to outpatients stays, which cost less. In short, Medicare Advantage plans continue to endanger hospitals and patients.
Patients are beginning to feel the unhappy consequences of insurer misbehavior towards hospitals. In some cases, Medicare Advantage plans are denying patients needed care or forcing them to jump through multiple hoops in order to get critical care. Hospitals are cancelling their Medicare Advantage contracts, leaving patients to scramble to find other network providers. This year alone, at least 17 hospital systems have cancelled or will cancel their Medicare Advantage contracts.
More than half the Medicare population is now enrolled in a Medicare Advantage plan, so hospitals tend to need the Medicare Advantage business. At the same time, they face financial risks when they contract with the insurers offering Medicare Advantage plans. S&P Global’s new report finds hospitals extremely vulnerable to Medicare Advantage bad acts.
The risks to hospitals is only growing, as the insurers in Medicare Advantage are wildly overpaid. It is more than likely that Congress and the administration will do more to eliminate these overpayments. When that happens, the hospitals will likely face even more challenges getting paid appropriately by Medicare Advantage insurers.
Another deep concern with Medicare Advantage is that there’s no counting on insurers to stay in business from one year to the next. Three big insurers, Centene, Aetna and Humana are saying they are pulling out of some of the Medicare Advantage markets in 2o25. The government and Medicare Advantage enrollees cannot rely on insurers to continue offering Medicare Advantage plans.
If they continue in business, there’s also no counting on insurers to keep their Medicare Advantage provider networks, cost-sharing and additional benefits. Insurers can narrow their provider networks, increase cost-sharing, and eliminate additional benefits. Everything can change.
“[W]e expect insurers to prioritize margin over membership, and we expect large insurers will use their scale and market clout to limit provider rate increases over what will prove to be a challenging contract negotiation season,” reports S&P Global.
Here’s more from Just Care:
- More hospitals are dropping Medicare Advantage
- How prior authorization requirements in Medicare Advantage could threaten your health
- AHA warns Medicare oversight agency about dangers of Medicare Advantage
- Low-income communities are particularly at risk in Medicare Advantage
- 2024: Too little known about Medicare Advantage
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