If you’re enrolled in a Medicare Advantage plan—a health plan offered by a corporate health insurer—or thinking about enrolling in one, you should be wondering whether you will be able to get the care you need from the hospitals you know and trust. Lots of hospital systems throughout the country, including St. George’s in Oregon, Mercy Health in Ohio, and Bon Secours, in Virginia, are rethinking the value of their Medicare Advantage contracts. We should all be asking our members of Congress why they allow insurers to underpay hospitals and to inappropriately deny care and coverage in Medicare Advantage.
In Ohio, Mercy Health has been in negotiations over its Medicare Advantage contract with Anthem, now Elevance Health, for a while. Mercy Health is not willing to accept the inadequate payments it gets from Elevance any longer. That said, Mercy Health continues to contract with other insurers offering Medicare Advantage.
Similarly, in Virginia, Bon Secours won’t agree to Anthem’s contract terms because of inadequate payments. People in Anthem’s Medicare Advantage plans and Medicaid managed care plans will be out-of-network in October if they use a Bon Secours provider.
Right now, problems with network adequacy in Medicare Advantage are severe, particularly in certain parts of the country. Throughout the US, rural hospitals are closing because of inadequate Medicare Advantage payments. Given that today the government massively overpays Medicare Advantage plans, which will end at some point, access to hospitals for people in Medicare Advantage is likely to get a lot worse.
Moreover, if more people enroll in Medicare Advantage, hospital systems will have less negotiating leverage with the Medicare Advantage insurers. (Traditional Medicare still puts some competitive pressure on Medicare Advantage plans.) And, more hospitals will be forced to accept Medicare Advantage plans’ inadequate payments or close their doors.
Provider networks are one of the many unknowns in Medicare Advantage. They are ever-changing. It’s impossible to know who’s in and who’s out at any given time. Health insurers in Medicare Advantage do not keep up-to-date provider directories, even though they are required to do so. They mislead people to enroll without informing them that they might not be covered for care from the hospitals and doctors they want to see.
Let your representatives in Congress know that they must end the denials and delays of care in Medicare Advantage and protect people with Medicare from disruptions in care because of unstable and inadequate provider networks.
Here’s more from Just Care:
- You still can’t trust Medicare Advantage plan provider directories
- Medicare Advantage endangers rural hospitals
- Hospitals find a lot wrong with Medicare Advantage
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Ten ways to improve Medicare Advantage
