by jerry on July 03, 2022
Kaiser Health News reported on some lingering problems with Medicare Advantage plans, which are plans that are administered by private companies and paid a set amount per patient. The idea was to give private industry a profit incentive to operate more efficiently than Medicare, allowing companies to keep savings. One problem is that the quality of health coverage provided by these plans is difficult to assess, and it is easier for to companies to cut corners to save money than it is for them to implement innovative techniques that both save money while maintaining or improving quality. This lack of transparency with quality can be particularly problematic since patients might make different decisions if they knew certain implications.
Complaints with Medicare Advantage plans including patients "facing 'unwarranted barriers' to getting care," perhaps at least in part explaining why "seniors in their last year of life had dropped out of Medicare Advantage plans at twice the rate of other patients leaving the plans."
On the financial side of the program, Medicare Advantage plans have an incentive to rate their patients as sicker than they actually are (to receive greater compensation), and an audit showed that "35 of 37 plans picked for audit had been overpaid, sometimes by thousands of dollars per patient."
It seems that the federal government is not receiving the intended value of Medicare Advantage plans. Even beyond that, the article reports that the Centers for Medicare and Medicaid (CMS) is over a decade behind completing audits, which can be a step towards rectifying some of the problem.