Health care professional warns against Medicare Advantage

Dear Editor,

Medicare’s open enrollment period commenced on October 15th and lasts through December 7th. During this period seniors can switch coverage between traditional Medicare and Medicare Advantage.

The Nebraska Hospital Association implores seniors in our state to know what your coverage looks like, especially for serious illness. Medicare Advantage can look appealing, but it usually does not offer the best care for many of the health situations seniors often face.

Medicare Advantage plans deny care more often than traditional Medicare and can delay your treatment when you need it most. Nearly all these plans require approvals and authorizations before care can be given. According to the Kaiser Family Foundation, 3.4 million requested authorizations were denied in 2022. Almost 98% of hospitals in Nebraska reported that Medicare Advantage’s prior authorization requirements negatively impact patients and delays necessary care.

Medicare Advantage patients also spend more time stuck in the hospital because the Medicare Advantage companies do not secure enough skilled-nursing and long-term care capacity for their plan participants. The most recent data from Nebraska hospitals showed that 46 Medicare Advantage patients were currently being unnecessarily held in a hospital more than a week after being medically cleared for discharge. This delays patients from receiving appropriate care, keeps them separated from family and community, and increases overall health care costs.

These plans also place substantial burdens on our doctors and nurses, who often must spend hours on the phone with insurers or send and resend documentation to make the case that the patient does in fact need the medical care they prescribed. Almost all (91%) of Nebraska hospitals report additional costs related to Medicare Advantage prior authorization policies, and 89% report these costs have increased over the last three years.

Medicare Advantage can switch your health care providers to be out of network at any time, resulting in unexpectedly high costs. By contrast, traditional Medicare beneficiaries can see any provider that accepts Medicare, which includes most doctors and almost all hospitals in the United States. Traditional Medicare patients don’t need a referral for specialists or mental health providers, and prior authorization is rarely required.

It is also important for Nebraska seniors to understand that not all Nebraska hospitals, clinics, and other health care facilities contract with Medicare Advantage plans. In fact, nearly one-third of Nebraska hospitals refuse to contract with certain plans. Seniors should consult with their providers before enrolling or switching to a Medicare Advantage plan.

The initial savings associated with Medicare Advantage may look enticing, but seniors should look further and understand the risks.

Do you have the best plan for your health care needs, budget, and location? Health care emergencies can happen. Does your plan make you wait for care? Could your plan deny care when you need it most?

Traditional Medicare is best for seniors if you have known health conditions or require prescriptions, prefer not to need a physician referral, want access to a broad scope of physicians and hospital networks, or want more predictable health care costs.

-Jeremy Nordquist, President of the Nebraska Hospital Association