[Special Edition]: Medicare Advantage: New Trends Raise Concerns about Access to Care

Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through private insurance companies. MA Plans adhere to the rules set by Medicare to cover beneficiaries, but their benefits are delivered by Medicare approved private companies. MA plans are part of a broader trend towards public sources of coverage, like Medicare and Medicaid, increasingly relying on private health plans to provide or administer their health benefits. Last year 42 % of all Medicare beneficiaries got their. benefits through private MA plans. Enrollment in these plans is growing at nearly 10% per year. There is serious concerns that coverage and patient access are being eroded as a result of health insurer efforts to restrict access and that there is a tremendous burden on health care providers to manage these insurer policies. In fact the HHS Office of Inspector General recently published a report finding that MA plans have exhibited a pattern of denying prior authorization and payment requests that would have covered by original Medicare. These types of denials have raised fears about certain insurer practices, which may impede beneficiary access to medically necessary care. Joining the podcast today to discuss the trends of how Medicare Advantage plans may affect patient care is Michelle Millerick, AHA's Senior Associate Director of Health Insurance Coverage. (Recorded at AHA's Annual Meeting in Washington D.C.)


Related Resources

Letter/Comment
Public
AHA urges CMS to take swift action to hold Medicare Advantage (MA) plans accountable for inappropriately and illegally restricting beneficiary access to…
Case Studies
ChristianaCare has teamed up with Kuumba Academy Charter School in Wilmington, Delaware, to establish a new student-based health center that will provide…
Advisory
Member
An arbitrator has ordered that Anthem Insurance Company, Inc. (“Anthem”) pay a group of 11 acute care hospitals in Indiana (“hospitals”) $4.5 million as…
Advancing Health Podcast
Public
Since the onset of the COVID-19 pandemic, digital solutions, including mobile health apps, patient portals and telehealth serve as a critical access point for…
Special Bulletin
Member
The Centers for Medicare…
Special Bulletin
Member
The AHA commends CMS on the updates to the network adequacy standards, which are critical to ensuring that patients have access to the care they need. We also…