Impact of Medicare Advantage (MA) Abuse on Seniors with Sunitha Reddy

In this episode: 

• What is Medicare Advantage (MA)? We examine the roots of this supplementary private health insurance coverage for seniors and its explosive growth, which now includes almost half of all Medicare beneficiaries (more than 28 million people). 
• There are increasing cases of abuse by insurance companies in charge of MA plans. Reports show they are denying and delaying doctor’s requests for necessary – and in some cases lifesaving - care. We discuss how this harms patients and burdens the hospitals caring for them. 
• We dive into how COVID-19 compounded the issues with MA as insurers continued adding barriers to care for seniors during surges. 
• How can we address MA issues? We highlight bipartisan efforts in Congress to fix the problem, like the Improving Senior's Timely Access to care Act. 
• Important to note - not long after our recording - CMS released two separate proposed regulations that address some aspects of prior authorization in Medicare Advantage, as well as Medicaid and ACA private plans. The two rules address some of the challenges highlighted in this podcast and the proposals may help to ameliorate certain of the abuses directly affecting patients that you will hear outlined. The proposed regulations are open for public comment.    

Guest: Sunitha Reddy, MBA, MPH, FACHE Chief Revenue Officer & Vice President, Operations, Prime Healthcare  

 

Medicare Advantage (MA) is on a growth path to become the dominant part of Medicare in many states across the country. This means that many of our most vulnerable seniors will, on one hand, receive the added benefits and discounts that these plans offer up front, but may find pathways to receive care more difficult than they bargain for – as insurance companies delay or even deny necessary care. Chip speaks to Sunitha Reddy about how this can be more than an inconvenience for patients – it can be harmful.