The analysis suggests that restrictive practices like prior authorizations contribute to this issue. While insurers deny this, the data shows that patients switching to traditional Medicare quickly access needed post-acute care, such as nursing homes.
Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home.
The 85-year-old was so weak and fragile, her son said, that she couldn’t even get herself out of bed. Her family felt she wasn’t ready to leave the facility in New York City’s Queens borough.
(Note: link has a paywall)
Mathews, A. W., Weaver, C., McGinty, T., & Greene, M. (2024, November 12). The sickest patients are fleeing private Medicare Plans—Costing taxpayers billions. WSJ. https://www.wsj.com/health/healthcare/medicare-private-plans-insurers-389af1a0
O’Connor, J. (2024, November 15). MA plans shed sickest patients in their final year of life, shifting costs back to government – McKnight’s Long-Term Care News. McKnight’s Long-Term Care News. https://www.mcknights.com/news/ma-plans-shed-sickest-patients-in-their-final-year-of-life-shifting-costs-back-to-government/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
