Stethoscope with medicare form with parts list in hand.

A leading provider association has joined the chorus of critics calling for change in Medicare Advantage plans. Late last week, LeadingAge called on the Centers for Medicare & Medicaid Services to adopt a list of recommendations to ensure MA beneficiaries get equitable post-acute access to services and care.

“Whether it’s delayed claims processing and opaque explanations for prior authorizations or slow care approvals, MA plan practices and policies impact the entire health care system,” Katie Smith Sloan, LeadingAge president and CEO, said in a statement. “Failure to address these and a host of other issues now will jeopardize the health and well-being of millions of older adults as the MA juggernaut expands. The time is right to take action.”

The list of recommendations LeadingAge sent to CMS include:

  • Making MA payment rates adequate and predictable
  • Understanding and addressing challenges with prior authorizations
  • Making value-based care payments workable
  • Ensuring beneficiaries have access to quality providers within MA plan networks
  • Addressing transparency concerns by improving data collection and sharing
  • Actively supporting beneficiaries rights and needs

MA plans have come under increased scrutiny as a growing number of older adults opt for the private health insurance plans over traditional fee-for-service Medigap plans. Last year, the Office of Inspector General accused MA plans of denying or delaying services to beneficiaries covered under Medicare. A subsequent report last month by Kaiser Family Foundation  found MA plans denied about 6% of prior authorization requests in 2021. 

Sloan stated that MA plans are at a critical juncture as they approach nearly half of the market in coverage for Medicare-eligible seniors. She urged Congress to address MA plan deficiencies, if CMS fails to act.

“Medicare beneficiaries deserve to receive the care they need, and providers, who deliver it, deserve to be paid in predictable, fair, and straightforward ways,” Sloan asserted. “We can do better.”