Jesse Smedley
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
People are increasingly choosing Medicare Advantage plans because they’re so heavily marketed and they offer extra benefits but. However, it’s important that you understand the pitfalls of Medicare Advantage plans because those aren’t as heavily advertised.
Medicare Advantage provides health coverage to more than half of the nation’s older adults but some Hospital systems and health systems are opting to end their contracts with Medicare Advantage over administrative challenges.
Two of the most commonly cited reason are access prior authorization denial rates and slow payments from insurers.
And the issue of preauthorization is a huge one amongst Medicare Advantage plans.
Preauthorization
Medicare Advantage Plans are managed care plans. That means that even if your doctor recommends a certain test of treatment for the care of your condition, your actual insurance company must approve it as well.
This means a lot of extra paperwork, follow up phone calls, and headaches. It can also mean denials and really scary bills. This is the last thing you want especially during a medical crisis. We’ve helped many clients with these issues before by switching to Medigap.
Medigap vs. MA
A recent survey of 135 Health System CFOs and found that 16% of the health systems across the country are planning to end their contract with one or more Medicare Advantage. 45% said that they’re considering the same but remain undecided. That could be your plan!
The report also found that 62% of CFOs Chief Financial officers of the hospital systems believe that collecting from Medicare Advantage is significantly more difficult than it was two years ago. It’s been getting progressively worse, so expect this trend to continue!
Even though some of these carriers and plans being dropped also offer Medicare Supplement Plans, these plans will remain unaffected. Medicare Supplements aka Medigap are not the same as Medicare Advantage.
Shrinking Networks
Providers and health systems can leave your network anytime. They can leave in January right after you signed up. But you cannot change plans until the next AEP, unless you qualify for a special enrollment period.
This will also affect your access to all the services your office uses to provide your medical care including lab work, diagnostic services, urgent care, hospital care and specialists.
