government

Medicare Advantage problems blamed for disenrollments

More public data on why enrollees leave private plans would help other seniors, the Medicare Rights Center concludes.

By Chris Silva — Posted June 30, 2010

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Medicare officials should resume a disenrollment survey they last conducted on private health plans in 2005 and provide the results to beneficiaries, concluded a report from the Medicare Rights Center, an advocacy organization based in New York.

Analyzing data and case notes from 475 cases in 2009, the report demonstrated that beneficiaries cite various reasons as to why they disenrolled from Medicare Advantage plans, including medical professional access problems (24.8%), misinformation and marketing misconduct by the plans (21.5%), coverage denials for medical services (19.4%), high cost-sharing (8.6%), and premium increases (3.2%).

Given the high incidence of reported problems with marketing abuse and doctor access, the June 15 report calls on the Centers for Medicare & Medicaid Services to strengthen oversight of plans' marketing practices and better educate consumers on Medicare Advantage coverage restrictions. "By understanding the reasons behind disenrollments, policymakers can identify problems both with the Medicare Advantage program as a whole and with individuals' plans," the report stated.

The Medicare Rights Center found that a large number of consumers are prompted to disenroll by more than one problem. For example, marketing abuses led some consumers to enroll in inappropriate plans, which then denied certain coverage for services.

In the most egregious cases, consumers were enrolled in Medicare Advantage plans after they were led to believe they were obtaining Medicare supplemental coverage or a stand-alone drug plan, the report said. Roughly 22% of beneficiaries who said they were misinformed before enrolling faced coverage denials for medical services under their new plan, nearly 14% found their prescription drugs were not covered as promised and just under 10% found cost-sharing was higher than expected.

But America's Health Insurance Plans responded that seniors in Medicare Advantage on the whole receive higher quality care, are subject to fewer preventable hospital re-admissions, and are less likely to have what are deemed "potentially avoidable" hospital admissions.

The organization pointed to an analysis released in fall 2009 that found Medicare Advantage beneficiaries in California and Nevada spent an average of 18% fewer days in the hospital than seniors in fee-for-service Medicare.

"More than 11 million seniors have chosen to enroll in a Medicare Advantage plan for the additional benefits and services these plans provide," said Robert Zirkelbach, an AHIP spokesman. "The vast majority of seniors have expressed very high satisfaction with their Medicare Advantage coverage."

A report released in December 2009 by the Government Accountability Office concluded that CMS has limited information about the number of Medicare Advantage beneficiaries who have experienced inappropriate marketing and recommended the agency gather more information on the issue.

Medicare officials said they plan to reinstitute the survey on private plans later this summer.

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