Keith Ellison, Minnesota’s attorney general, is trying to hold Humana accountable for misrepresenting the in-network providers in its Medicare Advantage plans, reports Rylee Wilson for Becker’s. It could be the first time that any state has acted to protect their older and disabled residents from misleading Medicare Advantage information. And, it’s about time.
For more than a decade, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, has reported that insurers mislead older adults and people with disabilities through inaccurate provider directories. But, CMS has never done anything to correct the problem, much less penalize insurers for misleading their enrollees.
In Minnesota, Ellison says that people considering joining a Humana Medicare Advantage plan are misled to believe that Humana will cover their care from Essentia Health, Avera Health, North Memorial Health and Sanford Health in 2025. But, all have said that they are leaving the Humana Medicare Advantage network at the end of this year.
In addition to correcting all misinformation in its provider directories as quickly as possible, Ellison wants Humana to detail which Medicare Advantage out-of-network providers it incorrectly listed as in-network this annual open enrollment season. He also wants Humana to protect enrollees who joined based on this misinformation. He argues that Humana should cover their care from these providers.
According to the Minnesota Star-Tribune, UnitedHealthcare also misleads people with Medicare about the providers in its network.
Over the last several months, many health systems have ended their contracts with Medicare Advantage insurers. These health systems not only cite huge administrative burdens they face with MA insurers but also large numbers of inappropriate denials of care.
If you enrolled in a Medicare Advantage plan because you cannot afford traditional Medicare, contact your Senators and representative in Congress. Urge them to add an out-of-pocket cap to traditional Medicare so that it is a meaningful choice for everyone with Medicare, not only a luxury for the wealthy. Only traditional Medicare covers your care from most doctors and hospitals anywhere in the country without requiring prior authorization or otherwise inappropriately delaying or denying medically necessary care.
Here’s more from Just Care:
- Senators ask Medicare agency why it is not holding Medicare Advantage plans accountable for violating their contractual obligations
- Government rules won’t curtail Medicare Advantage bad acts without stiff penalties
- Avoid bad Medicare Advantage plans
- 2024: What to know this Medicare Open Enrollment Period
- Well-kept secrets of Medicare Advantage plans