Medicare Advantage plans marked by shortcomings

The New York Times reports that these problem areas include rejection of claims for medical services and limits on prescription drug coverage. News outlets also report on ACOs grades and Medicare Advantage rate shifts. 

The New York Times: U.S. Finds Many Failures In Medicare Health Plans
Federal officials say they have repeatedly criticized, and in many cases penalized, Medicare health plans for serious deficiencies, including the improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs (Pear, 10/12).

Modern Healthcare: Pioneer ACOs Get High Marks From Patients, Mixed Grades On Quality
Medicare's first and most sophisticated accountable care organizations scored highly with patients for easy access to care and clear communication with doctors. The ACOs' success at preventing potentially avoidable hospital stays was decidedly more mixed, as was quality performance in areas such as diabetes management and patient involvement in healthcare decisions (Evans, 10/10).

Philadelphia Inquirer: Medicare Advantage Rate Shifts Hits Insurance Firms, Seniors
In June, Anthony Capone said he liked his AmeriHealth Medicare Advantage plan so much he persuaded his 89-year-old mother and aunt to make the switch. Things were going along fine until recently, when the Mount Laurel businessman's renewal notice arrived in the mail. He opened the package and was taken aback. His monthly premium had spiked to $62 a month, a $23 rise. Other fees - in-hospital co-pay (up to $175), Part D deductible ($25), and ambulance ($100) - have also risen. The hikes, Capone says, weren't a catastrophe for him. But his mother and aunt are another story. "She's on Social Security and has a small pension," Capone, 66, says. "Although it's only $30 or $40 a month, it affects her and people in her generation with a limited income." Across the country, Medicare Advantage beneficiaries are opening renewal letters and finding higher monthly premium payments, co-pays, and other fees. (The enrollment period is Oct. 15 to Dec. 7) (Calandra, 10/12).

And, in Alaska -

Alaska Dispatch News: Ancorage Hospital To Acquire Medicare Clinic
Alaska Alaska Regional Hospital has plans to acquire an Anchorage clinic that has relied on state money to cover its bills. The facility, Alaska Medicare Clinic, operates under an unusual business model, treating only patients 65 and older who carry Medicare - federal health insurance shunned by many doctors who protest that its reimbursement rates are set too low. ... But Dr. George Rhyneer, the retired cardiologist who spearheaded the clinic's creation, calculated that with the right mix of registered nurses, medical aides and patients, a Medicare-only primary care hub in South Anchorage could succeed (Hanlon, 10/11).

http://www.kaiserhealthnews.orgThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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