Saturday, July 13, 2024

Does Your Doctor Still Accept Medicare Advantage? Make Sure ASAP

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If you have signed up for Medicare Advantage coverage, it might be wise to double-check to make sure all of your doctors and pharmacies will accept the 2024 plan you are signing up for.

Becker’s Hospital Review reports that some major U.S. health care systems either have canceled contracts with Medicare Advantage providers or plan to do so soon.

Private insurers offer Medicare Advantage plans, which are an alternative to the government’s Original Medicare (also called traditional Medicare). That has meant those who sign up for Medicare Advantage plans typically are restricted to using health care providers who are part of a network, while in most cases Original Medicare lets you go to any doctor or hospital that takes Medicare patients.

Thus, enrollees in some Medicare Advantage plans could be in for a rude shock next year if one or more of their providers no longer is in their insurer’s network.

Becker’s reports that hospitals and health systems have grown disenchanted with Medicare Advantage plans because of what the providers view as high rates of denied requests for prior authorization and delayed payments from insurers.

San Diego-based Scripps Health is one health system that has announced it is ending Medicare Advantage contracts for its integrated medical groups, which employ more than 1,000 doctors, according to the Becker’s report. Impacted patients could include those enrolled in coverage from UnitedHealthcare, Anthem Blue Cross, Blue Shield of California and Centene’s Health Net.

St. Charles Health System — based in Bend, Oregon — is another health system dropping some Medicare Advantage plans.

Becker’s reports that more than a dozen hospital systems nationwide have recently terminated Medicare Advantage contracts.

The stakes are high for millions of Medicare recipients. Just over half of eligible Medicare beneficiaries — 51% — are enrolled in Medicare Advantage plans, according to KFF. In terms of raw numbers, that is 30.8 million people out of the 60 million who have both Medicare Parts A and B.

The Medicare open enrollment period for 2024 coverage is already underway and will end soon, on Dec. 7. So if you recently signed up for a Medicare Advantage plan for 2024 or soon will, now is the time to confirm that your health care providers will accept that plan.

If you have not yet chosen your Medicare coverage for next year, educate yourself before you make this key decision. You can start by reading “7 Signs You Should Change Your Medicare Coverage This Open Enrollment.”

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