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27 May, 2024

How Do MEDICARE ADVANTAGE Providers Exploit Seniors? Follow The Money!

icon healthcare,Medicare Advantage,Seniors
How Do MEDICARE ADVANTAGE Providers Exploit Seniors? Follow The Money!

"When ‘Prior Authorization’ Becomes a Medical Roadblock"

Medicare Advantage plans say it reduces waste and inappropriate care. Critics say it often restricts coverage unnecessarily...In 2021, those plans received more than 35 million prior authorization requests, according to a KFF analysis, and turned down about two million, or 6 percent, in whole or in part. Medicare Advantage has never saved money for the Medicare program.

Medicare Advantage plans get a fixed amount of public dollars per patient each month and can keep more of those dollars if prior authorization reduces expensive services. “Plans are making financial decisions rather than medical decisions,” said David Lipschutz, associate director of the nonprofit Center for Medicare Advocacy. - NY Times

How do the CEOs of Medicare Advantage providers make millions every year while denying healthcare to thousands of struggling seniors? Who are the biggest Medicare Advantage providers? How much do they spend on lobbying every year? How have the Republican tax cuts for the wealthy helped these CEOs? Follow the money and denied healthcare coverage with this map which uses data from the Kaiser Family Foundation (KFF).

Medicare Advantage providers mapped.
Follow the money and lobbying expenses

What is 'Prior Authorization'?

Prior authorization is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit will be covered by a patient’s insurance. While prior authorization has long been used as a tool to contain spending and prevent people from receiving unnecessary or low-value services, there are some concerns that current prior authorization requirements and processes may create barriers and delays to receiving necessary care, as well as exacerbate complexity for patients and their providers. - KFF

How Do MEDICARE ADVANTAGE Providers Exploit Seniors? Follow The Money!
Follow the money

Widespread problems

In 2018, a report found “widespread and persistent” problems related to denials of prior authorization and payments to providers. It noted that Advantage plans overturned 75 percent of those denials when patients or providers appealed. In 2022, a second inspector general’s report revealed that 13 percent of denied prior authorization requests met Medicare coverage rules and probably would have been approved by traditional Medicare.

TakeAway: Follow the money to see how Medicare Advantage provider CEOs make millions while seniors are denied healthcare. And political donations to Republicans let these CEOs pay less in taxes. Vote for President Biden and Democrats to protect your healthcare and lower insurance costs.

DISCLAIMER: ALTHOUGH THE DATA FOUND IN THIS BLOG AND INFOGRAPHIC HAS BEEN PRODUCED AND PROCESSED FROM SOURCES BELIEVED TO BE RELIABLE, NO WARRANTY EXPRESSED OR IMPLIED CAN BE MADE REGARDING THE ACCURACY, COMPLETENESS, LEGALITY OR RELIABILITY OF ANY SUCH INFORMATION. THIS DISCLAIMER APPLIES TO ANY USES OF THE INFORMATION WHETHER ISOLATED OR AGGREGATE USES THEREOF.

Image credit: Unsplash

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