No end in sight on Medicare Advantage debate

May 18—More than 30 million Americans 65 or older use Medicare Advantage, but an increasing number of hospitals are investigating the possibility of no longer accepting the health plan from certain providers.

Medicare Advantage is health insurance for seniors sold through private companies, like Blue Cross Blue Shield, United Health Care and Humana, that takes the place of Medicare. Many companies also offer Medicare supplements as an add-on to government Medicare.

In Northwest Missouri, the only hospital to drop private Medicare Advantage has been Cameron Regional Health Center, which will stop taking versions offered by Aetna and Humana at the start of 2024. Cameron hasn't accepted Cigna's Medicare Advantage plans since the start of 2023.

Cameron Regional's plan moving forward is to only accept Advantage plans from United Health Care and Blue Cross Blue Shield, which still comprise a major portion of the hospital's patients. Medicare Advantage patients make up about a quarter of those Cameron Regional sees, with United alone accounting for 13% of total patients, Cameron Regional CEO Joel Abrutz said.

"The government talks a good game about limiting this, or check and balancing that, but it's not working," he said. "The ads are still the same, agents are fraudulently going door-to-door to elderly patients."

But not everyone holds the same opinion. St. Joseph resident Tim Tucker sees the additional coverage as something everyone should have, though he recommends doing personal research to decide which plan fits a person's specific needs.

"The best plan of attack is to go to an insurance agent who knows what they're doing and is handling the supplements and ask them the particulars on coverage," he said.

Mosaic Life Care, Northwest Missouri's predominant health care network, has said it has no plans to stop accepting Medicare Advantage.

Nationally, numbers have been steadily climbing for almost 20 years, from 2007 when less than 20% of qualified Americans were enrolled, according to the non-profit research organization KFF. There were 30.2 million people enrolled in Medicare Advantage in January 2023 out of 59.8 million Americans who qualified, according to KFF.

Local health insurance agent John Anderson has seen a similar trend with customers in Northwest Missouri. A decreasing number of people Anderson deals with still choose Medicare supplements over Advantage.

He attributes the change, in part, to the difference in premiums. Out-of-pocket costs for supplement plans often increase the older customers get, but some Advantage plans have no cost up front, Anderson said.

"A lot of my customers are paying over $4,000 for their Medicare supplement plan," he said. "And the premium on this is zero, and that's what confuses people, is the zero premium. And they can do that because the government pays them so much, and then they don't have to do the claims or anything like that."

Having an Advantage plan is a necessity because of the breadth of services it provides access to, such as incentives for gym memberships, and assistance paying for glasses or hearing aids, which might not be covered with government Medicare, Tucker said.

One of the most recent hospitals to stop accepting some Advantage plans is Vanderbilt Health System, which began declining Humana and Wellcare of Tennessee plans in April.

Advantage programs came under fire last year for commercials featuring celebrities, a choice that the Biden Administration heavily scrutinized for potentially misleading customers.

But that could be just a means of drumming up business rather than an attempt to deceive potential customers, Tucker said.

"They don't bother me or confuse me because I've been in the program for so long. I pretty much know what they're talking about," he said. "And I don't think that they try to, really, mislead people. I think all they're trying to do is to enroll more people in their particular program."

In terms of compensation, accepting Medicare Advantage could be a larger loss than other, similar services for hospitals. Cameron Regional receives roughly 45 cents on the dollar for federal Medicare and 40 cents for inmate care but 30 to 35 cents for Medicare Advantage, Abrutz said.

"It's not beneficial for the American provider because the reimbursement they get from a Medicare Advantage is less than government Medicare (and) in a lot of cases, less than inmate care reimbursement," he said. "We are pruning the tree of Medicare Advantage limbs."

Alex Simone can be reached at alex.simone@newspressnow.com. Follow him on Twitter at @NPNOWSimone.

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