Weak Care Access Plagues Some Dying Medicare Plan Enrollees: GAO

What You Need to Know

Witnesses talked about Medicare plan provider network problems at a House subcommittee hearing Tuesday.
Most Medicare Advantage plan enrollees like the program and stay in the program.
When enrollees are in their last year of life, they are much more likely to run into problems and drop out, according to GAO.

One way advisors can help older clients: Call a few of the specialists in their Medicare Advantage plan directories and make sure that a high percentage of them are still in business and still accepting new patients.

That’s a takeaway advisors might draw from a new batch of written testimony that the  Government Accountability Office presented Tuesday at a House Energy and Commerce oversight subcommittee hearing on the Medicare Advantage plan program.

One topic that came up was that some Medicare Advantage plans have problems with the processes they use to decide whether they should cover care or pay claims.

Leslie Gordon, GAO’s acting director for health care, also raised another point: Some Medicare Advantage plans have skimpy provider networks or misleading provider network directories, and those provider network weaknesses can make patients miserable in their last year of life.

“In particular, provider networks may provide limited access to specialized care,” Gordon and other GAO officials said in the written version of the testimony.

GAO has given the Centers for Medicare & Medicaid Services ideas in the past about how to improve Medicare Advantage plans’ provider networks and provider directories, but “as of March 2022, the recommendations had not not yet been fully implemented,” officials said.

What It Means

Many advisor clients will avoid Medicare Advantage plan provider network problems by sticking with “Original Medicare,” in combination with Medicare supplement insurance, and many of the clients who sign up for Medicare Advantage plan coverage will end up in plans with excellent provider networks.

But insurance agents or financial advisors with the staff resources might be able to provide an important value-added service by calling 10 of the specialists in a client’s Medicare plan provider directory at random to check the accuracy of the directory, or by hiring a directory checking service.

The Background

The original Medicare program comes with many complicated deductibles and other coverage holes.