UnitedHealth, Humana and other major insurers offering Medicare Advantage plans, corporate health plans that contract with the government to provide coverage to people with Medicare, already are laying the groundwork for higher government payments and/or cost increases for their enrollees. Paige Minemyer reports for Fierce Healthcare that these insurers claim that people are using a lot more healthcare this year and that their costs are rising.
In filings to the Securities and Exchange Commission, Humana and United Healthcare claim that they will be spending .87 cents of every dollar they receive from the government on benefits. They attribute this increase to greater use of outpatient services, emergency care and surgeries by their enrollees with Medicare. Humana also claims that it has seen greater enrollment by older people with Medicare, who cost them more than younger people.
United Healthcare has seen greater use of behavioral health services. Still, both companies have been able to contain inpatient costs. And, United Healthcare has been able to keep medical spending down to as low as 0.821 cents on the dollar.
The major health insurers all appear to attribute higher use of health services this year to delayed care because of the Covid-19 pandemic. But, whatever the reason, they are still engaged in widespread inappropriate delays and denials of care and coverage and, this year alone, are overcharging the federal government as much as $75 billion for their services, according to a new study.
Congress is sitting on its hands, notwithstanding the massive overpayments to Medicare Advantage plans and the widespread inappropriate delays and denials. As troubling, the administration is still suggesting that people can choose a Medicare Advantage plan that’s right for them, even though they are not warning people about the Medicare Advantage plans that are engaged in widespread inappropriate delays and denials of care or cancelling their contracts.
Here’s more from Just Care:
- What happens when Medicare Advantage overpayments end?
- Case study: Medicare Advantage delays, denials and consequences
- OIG finds widespread inappropriate care denials in Medicare Advantage
- How prior authorization requirements in Medicare Advantage could threaten your health
- Traditional Medicare v. Medicare Advantage? Different as night and day
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