Medicare Advantage plan documents sitting on a table
Credit: zimmytws/Getty Images Plus
Medicare Advantage plan documents sitting on a table
Credit: zimmytws/Getty Images Plus

Congressional lawmakers are being urged to address weaknesses in Medicare Advantage plans in response to a federal watchdog report that found that the MA organizations have often improperly denied or delayed care to seniors. 

Seniors “may not be aware that they may face greater barriers to accessing certain types of healthcare services in Medicare Advantage than in original Medicare,” said Erin Bliss, assistant inspector general for evaluation and inspections at the Office of Inspector General, said Tuesday. 

Bliss was a witness at a hearing held by the House Committee on Energy & Commerce subcommittee for oversight and investigations, first reported by Kaiser Health Network.

The hearing specifically focused on the oversight of MA plans and also included statements by Leslie Gordon, acting director on the Government Accountability Office’s healthcare team, and James E. Mathews, Ph.D., executive director of the Medicare Payment Advisory Commission. 

An April report by the OIG accused MAOs of sometimes delaying or denying Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules.

Post-acute facilities were among the healthcare services often involved in denials that met Medicare coverage rules. The findings spurred an immediate call for change from stakeholders and providers who have struggled with the potential cost of admitting some residents due to the issue in recent years.

“Medicare Advantage beneficiaries in the last year of life are generally in poor health and often require high cost, specialized care,” Gordon said during the hearing Tuesday. “High rates of disenrollment from Medicare Advantage to join traditional Medicare may indicate issues with the quality of care, such as potential limitations accessing specialized care.” 

Gordon added GAO has also found that MA beneficiaries in the last year of life disenrolled to join traditional Medicare at more than twice the rate of other Medicare beneficiaries. 

Lawmakers on Tuesday agreed with the concerns and called for improvements. Seniors should not be “required to jump through numerous hoops” to gain access to healthcare, said subcommittee chair Rep. Diana DeGette (D-CO). 

LeadingAge is advocating for a provider rights’ addition to MA programs that would better enable nursing homes and other aging services organizations to deliver services and be fairly reimbursed for them.

“We know nearly half of Medicare beneficiaries are now enrolled in Medicare Advantage and post-acute providers need to see some changes in MA policies to ensure that they can serve these beneficiaries well,” Ruth Katz, the organization’s senior vice president of public policy and advocacy, said during a call with members Wednesday afternoon.

“The MA program is popular and gets more and more popular both with policymakers and with consumers because of the lower beneficiary out-of-pocket costs…but these are concerns and they have to be addressed,” she added. “We are pushing the administration and Congress to keep this issue on their radar and in their sights.”