GAO Report Shows Problems in Medicare Advantage Plans

A Democratic blog out of Texas, linking to one of my many previous posts on the problems with Medicare Advantage plans, also points out a new GAO report on Medicare Advantage plans (pdf format). After pointing out the financial problems with the plans costing 13 percent or 17 percent more to care for Medicare patients than under the government plan, they point out a few key problems with the plans:

Beneficiaries May Be Charged For Entire Cost Of Service: If beneficiaries in PFFS plans did not contact their plans before obtaining services to ensure that the service was covered, they may have had to “pay for the entire cost of the service if the coverage was later denied.” Enrollees in original fee-for-service Medicare are not charged the entire cost of a service unless the provider warns him or her that it may not be covered by Medicare.

Beneficiaries Charged Higher Cost Sharing: PFFS plans charged exorbitant cost-sharing to beneficiaries who did not “prenotify” a plan before obtaining services, a practice that may have violated laws governing PFFS plans. Medicare FFS plans, HMO, and PPO plans did not have prenotification requirements.

PFFS Plans Are Unpopular: Beneficiaries are noticing the poor treatment they’ve received from PFFS plans and are voting with their feet and are disenrolling at an average rate of 21 percent compared to 9 percent for other MA plans. The Center for Medicare and Medicaid Services did not comply with statutory requirements to mail information on MA plan disenrollment rates to beneficiaries.

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