May 02, 2022

HHS Investigation Finds Many Medicare Advantage Enrollees are Denied Necessary Care

Medicare Advantage (MA) plans have grown in popularity, with enrollment more than doubling over the last decade. However, an investigation conducted by the HHS Inspector General found that tens of thousands of enrollees are denied care that should be covered under the program.

Advantage plans offer a privatized version of traditional Medicare coverage, and they sometimes offer less expensive options or a wider array of benefits. However, the price can be delays or denial of needed medical care which Medicare requires MA plans to cover.

Tens of millions of denials are issued each year for both authorization and reimbursements by the MA private insurers, and the report found “widespread and persistent problems related to inappropriate denials of services and payment.” Hospitals and doctors complained about the insurance company tactics for years, and Congress is considering legislation to address those concerns.

“Medicare Advantage plans too often give insurance companies too much power to make medical decisions,” said Joseph Peters, Jr., Secretary-Treasurer of the Alliance. “MA plans are contractually obligated to follow all of Medicare’s required coverage rules, and in many cases they are not. HHS needs to hold all MA plans accountable and ensure they deliver the health care benefits patients need when they need it.”