Medicare-Potentially Disturbing News

I recently read a GAO report (Government Accounting Office) that mentions
that the rate of unenrollment in a Medicare Advantage Plan (MAPD) is twice
as high in the last year of life. While the statistics are correct, not sure if
their conclusions are?

Their conclusions are based on information garnered during 2016 and 2017,
which shows the unenrollment rate from MAPD plans for those in their last
year of life are around 4.5% while normal unenrollment’s are about 1.7 to
2.0%. They base this information on the assumption that the folks aren’t
getting the level of care needed during the last stage of life so therefore the
MAPD plans aren’t providing the level of care needed because of cost.

Meaning that the MAPD plans are either denying or delaying approvals for
the level of care needed at that stage of life. Of course, the costs associated
with the last stage of life can be very expensive, so the individual goes back
to Original Medicare for the medical services that are needed. The only
restriction in Original Medicare is the doctor or hospital allowed to treat
Medicare recipients? If they are not a Medicare doctor or hospital you can
use them, but you will pay the entire cost. Those on Original Medicare pays
20% of the bill and in some cases pay 35% of the bill, so choosing that
option has a significant financial risk to the Medicare recipient. Additionally,
you can only change your MAPD during AEP (October 15-December 7 and
the during OEP (January 1-March 31). So, if MAPD recipients can only
change during that timeframe, perhaps the data is incorrect?

I wish the GAO could prove these assertions with information substantiating
these claims are based on reviewing the medical information from these MAPD
plans to validate those assertions. While the assertion appears to be
accurate regarding dis-enrollment rates, the actual proof through case
studies are either missing from these reports or not being made available to
the public.

The report did mention that the dis-enrollment rates among Regional PPO
plans are significantly higher than with HMOs. While those statistics may be
accurate it doesn’t fit a logical conclusion. PPOs in general allow you to
change your doctor whenever you want so the lack of care doesn’t track in
my mind? If I can change my doctor and one isn’t providing the care, I can
choose another one monthly if needed. If the plan doesn’t have enough
doctors needed for the medical condition, that is a different situation and
CMS needs to deal with that problem.

The conclusion I drew is that there is data substantiating the dis-enrollment
rate the conclusions are lacking definitive proof of these assertions. I truly
hope I am correct because I would not be comfortable placing any of my
clients in MAPD plans that are not taking care of the client.

I’ve been in the Medicare space offering insurance solutions for over 17
years and while I have seen some difficulty in getting in to see the doctor, I
have not heard any case where care was not provided, regardless of the
medical situation.

As stated previously, would like to see specific cases (without revealing the
patient or insurance company) that substantiates these assertions from
CMS.

The Barend Agency Inc.

Len Barend, broker

702-250-2200
www.insurance4unevada.com

len@insurance4unevada.com

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