Denial

Blog readers will know a) over half of the Medicare-eligible population is now in privatized Medicare Advantage plans, and b) at one time UCOP pushed to have all folks under retiree health insurance in Medicare Advantage, but pulled back when there was resistance, c) Medicare Advantage premiums for retirees tend to be cheaper than traditional Medicare-plus-supplement arrangements.

Medicare Advantage plans often offer extras such as gym memberships to attract participants. But the issue is what happens when someone has a serious health issue and needs expensive care. Newsweek finds high denial rates in Medicare Advantage plans, but persistent appeals will often reverse the denial:

Private Medicare plans are denying requests for specialized medical care at widely varying rates. In some cases, denial rates were strikingly high, especially for some of the largest Medicare Advantage companies: CVS Health/Aetna, Humana and UnitedHealth Group, according to a new inspector general report.

Some of these insurers, while being some of the most prominent in the U.S., routinely reject requests for post-hospital care such as rehabilitation and long-term treatment

• Check plan rules carefully for post-hospital care
• Be prepared for prior authorization requirements
• Consider appealing any denial, as reversal rates can be high
• Compare plans not just on premiums—but on coverage rules and approval patterns...

Full story at https://www.newsweek.com/medicare-plans-compared-based-on-denial-rates-for-specialized-care-12075121.

What this story is saying is that when a health crunch occurs under a Medicare Advantage plan, you may get treatment denial - although after a hassle, the negative decision might be reversed. It would be worth tracking whether that has been the experience under the Medicare Advantage offerings of UC.