Mass General Brigham Health Plan just announced that it is discontinuing Dana-Farber Cancer Institute, a renowned cancer center of excellence, from its Medicare Advantage network, reports Elizabeth Gregerson for Becker’s Payer Issues. While Mass General doesn’t explicitly say so, you can read between the lines that it’s because having Dana-Farber in its network drives up its costs. Since you never know what care you’ll need, you’re best off staying away from Medicare Advantage, even if you’re healthy now.
No Medicare Advantage plan markets to people with cancer. You won’t see any Medicare Advantage plan promoting an excellent cancer care program, even though people should be choosing a health plan on how well it delivers care to people with complex conditions. The insurers offering Medicare Advantage don’t want to attract people with complex conditions. They drive up costs and eat into profits.
Here’s the explanation Mass General gives for cancelling Dana-Farber: “This change is due to the challenging environment that is impacting Medicare Advantage plans nationwide.” If you ask me, that’s code for “It’s too expensive.” To be clear, overall, the insurers receive more money per person in Medicare Advantage than taxpayers spend on individuals in traditional Medicare, but they are less efficient.
What’s more concerning is that the government pays Medicare Advantage insurers a “capitated” fee, a fixed payment per enrollee. This creates a powerful incentive for insurers to attract people who use little or no health care and avoid people who use more than the fixed amount they receive to treat them. The fewer sick people they enroll, the more they profit.
For this reason, people in Medicare Advantage plans always take the risk that they will not be able to see the doctors or use the hospitals they need to use when they develop a complex condition, be it cancer or heart disease or kidney disease. Even if insurers have high quality in-network providers when you enroll–which is too often not the case– the providers can leave at any time of their own choosing or because the insurer wants them out.
Here’s more from Just Care:
- The many disadvantages of Medicare Advantage
- Medicare Advantage insurers increasingly use step therapy for cancer drugs, delaying care
- Medicare Advantage plans create hurdles for people with diabetes
- Need costly care in Medicare Advantage? Expect a denial
- OIG finds widespread inappropriate care denials in Medicare Advantage
