30 health systems dropping Medicare Advantage plans
 

https://x.com/CarolynMcC/status/1851217718759862390

30 health systems dropping Medicare Advantage plans | 2024
must register to read but is free to register, or hit the already a member link, and then close the login box, and read the article. . (my hack)

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Medicare Advantage provides health coverage to more than half of the nation's older adults, but some hospitals and health systems are opting to end their contracts with MA plans over administrative challenges.

Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers.

In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.

Data on this topic is limited. In January, the Healthcare Financial Management Association released a survey of 135 health system CFOs, which found that 16% of systems are planning to stop accepting one or more MA plans in the next two years. Another 45% said they are considering the same but have not made a final decision. The report also found that 62% of CFOs believe collecting from MA is "significantly more difficult" than it was two years ago.

30 health systems dropping Medicare Advantage plans in 2024:
Editor's note: This is not an exhaustive list. It will continue to be updated this year

Robbinsdale, Minn.-based North Memorial Health is ending its contract with Humana Medicare Advantage, effective Dec. 31, 2024.

Watertown, S.D.-based Prairie Lakes Healthcare System will drop Humana Medicare Advantage in 2025.

North Kansas City (Mo.) Hospital and Meritas Health will no longer be in-network with Aetna Medicare Advantage plans, effective Oct. 1, 2024.

Nashville-based Vanderbilt Health will no longer be in network with BCBS Tennessee Medicare Advantage, effective in 2025.

Sioux Falls, S.D.-based Avera Health will end participation as an in-network provider with Humana Medicare Advantage on Dec. 31, 2024.

Duluth, Minn.-based Essentia Health will no longer accept UnitedHealthcare and Humana Medicare Advantage in 2025.

Quincy, Ill.-based Blessing Health is implementing a new MA approach in 2025 and will only contract with BCBS, UnitedHealthcare, Molina and Total Retiree Advantage Illinois.

Lawrence, Kan.-based LMH Health will no longer accept Aetna or Humana Medicare Advantage, effective Jan. 1.

Brewer, Maine-based Northern Light Health is ending its Medicare Advantage contract with Humana, effective Sept. 30.

Sioux Falls, S.D.-based Sanford Health is dropping Humana Medicare Advantage in Minnesota in 2025.

North Platte, Neb.-based Great Plains Health will no longer accept any Medicare Advantage plans in 2025.

Kimball (Neb.) Health Services will no longer accept any Medicare Advantage plans starting in 2025.

Carson City, Nev.-based Carson Tahoe Health will no longer be in network with UnitedHealthcare Medicare Advantage by May 30, 2025.

Midland-based MyMichigan Health will no longer participate in the Aetna Medicare Advantage Network at all facilities after Dec. 31.

Bloomington, Minn.-based HealthPartners will no longer be in network with UnitedHealthcare Medicare Advantage plans by 2025.

Canton, Ohio-based Aultman Health System's hospitals will no longer be in network with Humana Medicare Advantage after July 1, and its physicians will no longer be in network after Aug. 1.

Albany (N.Y.) Med Health System stopped accepting Humana Medicare Advantage on July 1.

Munster, Ind.-based Powers Health (formerly Community Healthcare System) went out of network with Humana and Aetna's Medicare Advantage plans on June 1.

Lawton, Okla.-based Comanche County Memorial Hospital stopped accepting UnitedHealthcare Medicare Advantage plans on May 1.

Houston-based Memorial Hermann Health System stopped contracting with Humana Medicare Advantage on Jan. 1.

York, Pa.-based WellSpan Health stopped accepting Humana Medicare Advantage and UnitedHealthcare Medicare Advantage plans on Jan. 1. UnitedHealthcare D-SNP plans in some locations are still accepted.

Newark, Del.-based ChristianaCare is out of network with Humana's Medicare Advantage plans as of Jan. 1, with the exception of home health services.

Greenville, N.C.-based ECU Health stopped accepting Humana's Medicare Advantage plans in January.

Zanesville, Ohio-based Genesis Healthcare System dropped Anthem BCBS and Humana Medicare Advantage plans in January.

Corvallis, Ore.-based Samaritan Health Services' hospitals went out of network with UnitedHealthcare's Medicare Advantage plans on Jan. 9. Samaritan's physicians and provider services will be out of network on Nov. 1.

Cameron (Mo.) Regional Medical Center stopped accepting Aetna and Humana Medicare Advantage in 2024.

Bend, Ore.-based St. Charles Health System stopped accepting Humana Medicare Advantage on Jan. 1 and Centene MA on Feb. 1.

Brookings (S.D.) Health System stopped accepting all Medicare Advantage plans in 2024.

Louisville, Ky.-based Baptist Health went out of network with UnitedHealthcare Medicare Advantage and Centene's WellCare on Jan. 1.

San Diego-based Scripps Health ended all Medicare Advantage contracts for its integrated medical groups, effective Jan. 1.

None in florida - who cares - Advantage is growing in number of enrollees

May be a negotiation ploy
 

I worked for a BCBS company. Hospitals, doctors, pharmacies routinely would threaten to drop their acceptance around contract renewal time as a negotiation method to improve the items mentioned - payment amounts, service, payment time, etc. Few providers can afford to drop the large carriers like Humana, BCBS, or United.
Next time you get an explanation of benefits from your insurance - look at the great difference between what the provider billed and what the insurance company paid (based on contract with the provider). If you did not have insurance, you most likely would be paying what the provider billed.
Medicare drives a lot the entire process but the insurance companies stand between us and Medicare (assuming you are in a MA plan). The insurance companies are held hostage to Medicare paying their claims too in a timely manner.

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You are correct. Typically around 1/3 of the billed amount is actually paid and accepted as payment in full. So, what is the actual fair value of the procedure? And what happens to the 2/3 that is not paid? And why should a person with no insurance pay more than the amount that Medicare pays?

You cannot be dropped from Advantage plan - same as Original Medicare

Don't know anyone that has happened to.....do you? It would be great if you could ask them to jump into this thread so we can have some first hand knowledge.

Hope that does not change. A lot of elderly folks in Central Florida

I wasn't clear in my post, we witnessed a hospital system dropping a Medicare Advantage plan in November such that patients had to find a different infusion center by January to continue their Chemo.

Unfortunately, ended up in the hospital for two days in September and just received my BCBS Hospital Claims Report. The bill was about $61k, hospital accepted $9411 as payment in full, crazy. Do they just dream up these charges?

Sounds to me like they are over billing so that the medicare advantage company will payout more in the end.

None in Florida, who cares? Does anybody travel while they are retired? Are you going to use this list so you don’t get near any of these places when you travel?
You think they are done adding to this list?
Advantage plans are flawed, all of these issues have been known for many years (almost 70% denial rates when Medicare does not deny any procedure), and they keep getting worse

Moffitt

OK, so 30 hospitals across the US are "dropping" advantage plans, subject to change depending on some last-minute negotiations. But to put it in perspective, there are 6,120 hospitals and over a million physicians in the US, so no biggie.

As far as billing goes, a provider is stupid if they don't set their fees at least 10% above the highest paying 3rd party insurer---it's just leaving money on the table, and since they generally accept insurance as full payment, it doesn't matter---UNLESS the patient has no insurance. Then it becomes ridiculously unfair especially if the provider is billing triple what they know they will get from insurance. Here's an example from 10-15 years ago. Medicare would reimburse a chem 12 profile about $13 at the time. Our best private insurance would pay $18. So we set the fee at $20. The hospital lab across the parking lot unbundled the CPT codes and charged $295 for the same thing---of course they got the same $13 and $18 as we did and accepted it (It costs about $7.75 to run the test). BUT.... while a patient with no insurance owed us $20, which we frequently just wrote off, they owed the hospital $295 if they went there, and the hospital would aggressively send them to collections. Completely ridiculous in my opinion. Just part of the reason our healthcare system needs some substantial changes.

it only happens if you don't pay, otherwise it's not going to happen. been there done that,

Many doctors and medical facilities don't accept Medicare ADVANTAGE because it doesn't pay enough for services. My wife and I signed up for Medicare SUPPLEMENT through MedicareSchool.com. The insurance agents only make about half (1/2) the commission on a SUPPLEMENT plan, but it's much better coverage. It covers many of the EXPENSIVE things that ADVANTAGE doesn't . . . Especially HOSPITALIZATION. If you can afford the MEDICARE SUPPLEMENT premium, you should probably get it. BTW: My wife and I are very healthy and take no meds, so an Advantage plan would be less costly for us NOW. But, as we age, things may change and you can't switch to a SUPPLEMENT plan if you have health issues. But, there are no such limitations if you sign up for a SUPPLEMENT plan when you turn 65.

Your source is a person on X, really! You believe what you see/read on Elon Musk's propaganda/misinformation site - SAD! If there are hospitals that are not accepting Medicare Advantage plans, it is because of greed! The areas of the USA that you site are probably poor demographics health wise. Nice try but no cigar!

There are plenty in Florida that have dropped MA. I had to change plans because Moffitt dropped Florida Blue Advantage. I have heard from doctor's offices that they are tired of fighting for payment and arguing over prior approvals. It's the insurance companies doing it, not the medical facilities.

Well said! This is spot on!

Actually, most MA plans pay exactly the same as original Medicare with a supplement

It says they may drop some of the plans- not ALL.

Be careful believing what you read on X (formerly twitter).

The copy and paste came from beckershospitalreview. . .
the X account reposted the link to beckers and I copied both the link and the article from the publication beckershospitalreview.com

Be careful posting misinformation because of failure to understand bbs links and webpages. .

Would not ever get an advantage plan. Too many denials for procedures according to friends who have them. Guess the company keeps the costs down that way...

The reason hospitals bill more is many contracts with private payors are set to reimburse a percentage of the amount billed. If company "X" pays 1/3 of billed, then the hospital has to bill 3x Medicare rates just to get the same amount from a private payor. Most private companies pay more than Medicare because Medicare isn't fair compensation for services and that's the dirty little secret! Medicare may change the way the pie is sliced, but the pie seldom grows beyond inflation. Medicare may increase the rate for some services, but they'll cut others to offset it. Over the decades I'd worked in radiation oncology, Medicare had bundled so many things at a MUCH LOWER overall amount. Imagine owning a car repair shop and someone comes in needing a tune-up, and the government says you can charge for the tune-up but not the new spark plugs or wires because that's bundled into the tune-up charge. The government would increase the reimbursement of the tune-up, but not by enough to cover plugs, wires, etc.

On the flip side, insurance companies would sometimes deny the first billing submission automatically without any good reason, just to be able to sit on and use the money a little longer. We would have insurance companies argue about how many treatments they'll pay for, in spite of how many it actually took to properly treat. Doctors would spend time at least weekly, doing peer-to-peer discussions with insurance companies having to explain why a patient needed "X" radiation treatment and their "peer" is some pediatrician with no significant knowledge of radiation oncology or even oncology! Then there's the endless requests for more documentation, even when treatment already has an authorization... just to hold the money a little longer. Then they'll deny week 3 of 5 weeks treatment!

It's not simple. Government price controls, insurance company greed, hospitals and doctors gilding the lily with care beyond what's reasonably justified. Maybe if we go to case-rates based on injury, decease, stage, etc. that removes all the arguments about what care is needed/justified.

I have an advantage plan that generally doesn't require pre-authorizations. My plan is also nationwide, so I can see my doctors here or up north and they're all in-network. Unlike Medicare, I have vision, dental, and some cash monthly for over-the-counter stuff. I went through an independent, Sphere Coverage Solutions Inc. Affordable Health & Life Insurance Plans in Florida & Beyond- Sphere Coverage Solutions to go over all the possible combinations of government/non-government plans to see what fit my needs best.

I don't believe that they are the same. And this article is about people getting dropped by hospitals from the advantage plans all around the country.

I agree. That is very true.

All this stated confusion naturally brings up the question of National Health Insurance. Is the system used by Canada, Australia, and all other 1st world countries (except the US) superior to the US's confused and inefficient system? Answer, yes they get better care at lower cost. Ask the Canadians why they are afraid to get sick while in the US.

Think about this. I have a UHC Supplement plan along with original medicare. Over the past few days, I've gotten multiple emails from UHC touting the fact that I may save money by switching to one of their 'free' (zero premium) advantage plans. Are they really trying to save me money or is it because they make more money on the advantage plans?

Canadian health care
 

I lived in Canada for five years, and found it just the opposite. As a personal example, I was having what appeared to be heart problems, and failed a stress test. It took me about 4 months to get a heart scan and see the cardiologist. I also had back problems, and the doctor signed me up for pain management. About six months later, I returned to FL, and a couple months after that, I got a call from Alberta Healthcare saying they were ready for me to start my pain management (don't know how they got my FL telephone number). A co-worker's mother had a steel rod in her spine that snapped, leaving her humped over in terrible pain. It took her 1.5 years to get into pain management, which immediately (finally) solved her pain. The main hospital in Edmonton was overcrowded, had roof leaks that impacted their operating rooms, and long waiting lists (which were jumped by people with the right connections). Wealthy Canadians went to the U.S. to get treated. And free healthcare isn't free--income taxes were about double, to pay for it.

That is what have heard.

You were fortunate they didn't recommend MAID. From what I have read they are doing that for a variety of reasons including being indigent, depression or no family caretaker. That could be the plan to reduce the demand for medical services.

Wrong and wrong...

You're ignoring the exorbitant waiting times (as seen in the UK) anf the significantly higher taxes (that EVERYONE pays) that are needed to fund their health care coverage...

While you're at it, ask them why they (and citizens from the other countries you mentioned, along with many others) come to the US to get much of the advance health care they cannot get at home...

Yup. Similar things happen in the UK... Many patients simply give up and come to the US for care...

UF Health (Shands) dropped United Healthcare this year
 

Actually health systems starting to drop some large carriers. Recently, the UF Health informed us that they are no longer part of the United Healthcare network starting this September. And we have a supplemental insurance through my employer. Not an advantage plan.

Coverage will continue until the treatment is complete
 

Correct. But your health provider can “drop” your insurance carrier. It happened to us this year with Shands and United Healthcare (which we had through my employer). Shands sent us a letter explaining that they would still be considered as an “in-network” provider for the duration of the treatment. Whatever that means. We are switching to a different plan next year.

Couldn't be more wrong. Their cost is slightly lower, but their tax rate is higher. The main cost savings is essentially "rationing" of healthcare both by denying certain services such as dialysis or ICU care in terminal cases and long waits for surgeries where the patient may die before any $$$ is spent. That may work in a society that is basically ethnically homogenous such as Sweden, but with the diverse population in the US someone will scream "discrimination", not to mention we have 10 times as many lawyers per capita to force that issue. And "better" care?????:1rotfl::1rotfl::1rotfl: That's the biggest misperception going. Why is it that Canadians who are financially able flock to the US for health care when they have a significant illness? Also, where do those who can afford it around the world come for quality health care---Boston, NY, or Luxembourg???? And don't even bother countering with those bogus WHO statistics on life expectancy---those numbers are all skewed by the different criteria we have for reporting infant mortality vs. the rest of the world. But if anyone wants to travel to Zimbabwe for their medical care, it's a free country, go for it.

Mayo Clinic in Jacksonville does not accept any Advantage… Moffit dropped Florida Blue Advantage, two of the best cancer hospitals in the state.

No but the hospital can stop accepting Advantage… I.e. Mayo Clinic and Moffit.

wrong… talked to a customer of mine once in Canada that was shocked I had my knee replaced at age 55. His mom at age 75 is on the waiting list at the time for 2 years. Hospitals in CA only do X amount of knees annually. He said it seemed like they are waiting for her to die. Another doctor I met while traveling who does knees said his brother was on the list. He would do his brother tomorrow but it was not allowed. UK is the same way. Many Canadians come to the US and pay out of pocket instead of waiting years.