Medicare Advantage plans are not the same thing as Medicare.


Medicare Advantage plans are not the same thing as Medicare. Medicare Advantage plans are private plans meant to take the place of Medicare coverage. You often see them carrying the names of their owners like United, Humana, and so forth. We are providing this message to make our community aware of a recent United States Senate Subcommittee report on certain dangers associated with Medicare Advantage. We reproduce some of its language below.

Doctors evaluate thousands of seniors recovering from falls, strokes, and other ailments, and enter a recommended course of treatment into an online portal… But whether the requested service is determined to be medically necessary is a decision that belongs to people at the other end of the line. This is prior authorization. And for beneficiaries of Medicare Advantage, the alternative to Traditional Medicare in which private companies contract with the government to administer health plans, it has become … a potential threat to their health.

On May 17, 2023, the Permanent Subcommittee on Investigations (“PSI” or “the Subcommittee”) launched an inquiry into the barriers facing seniors enrolled in Medicare Advantage in accessing care. This Majority staff report reveals how Medicare Advantage insurers are intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities. Insurer denials at these facilities, which help people recover from injuries and illnesses, can force seniors to make difficult choices about their health and finances in the vulnerable days after exiting a hospital.

Between 2019 and 2022, UnitedHealthcare, Humana, and CVS each denied prior authorization requests for post-acute care at far higher rates than they did for other types of care, resulting in diminished access to post-acute care for Medicare Advantage beneficiaries.

In 2022, both UnitedHealthcare and CVS denied prior authorization requests for post-acute care at rates that were approximately three times higher than the companies’ overall denial rates for prior authorization requests.

In that same year, Humana’s prior authorization denial rate for post-acute care was over 16 times higher than its overall rate of denial.

These are just a few of the points found in the report. You can read the entire thing here. https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf

Make sure that you understand that, for those not on traditional Medicare, these same scenarios may apply to you or your family members. Please speak with your physician or other primary care provider before making a decision on your Medicare coverage.