For Americans 65 and older, Medicare Advantage, commonly known as Medicare Part C, is a well-liked type of health insurance.
Yet, selecting the best plan can be challenging because there were 4,064 different Medicare Advantage plans available nationwide in 2023 alone, and choosing the best insurance is very individualized to the individual.
Navigating Medicare Advantage
In order to see a list of plans for which you are eligible, you must provide your ZIP code and some demographic information, and even then, you will likely only be able to compare the details of approximately 39 options.
You can start by focusing on the health insurance providers that, on average, offer the best Medicare Advantage plans, based on factors like provider network size and additional benefits and coverage.
However, the best way to navigate this overwhelming task is to seek the help of an independent, unbiased health insurance agent.
The Centers for Medicare & Medicaid Services (CMS) recommended modifications to Medicare Advantage on February 1 with the goal of reducing rampant coverage denials and systematic overbilling that cost the government tens of billions of dollars.
The initiative targeted upcoding, which occurs when businesses add several bogus or unrelated diagnoses to generate risk-adjusted payments that provide more to insurers who treat sicker patients.
Reimbursement rates would be decreased and thousands of codes that don’t need extra care would be removed.
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Industry Pressure Wins Over Patient Protection
The final payment rate rule was published by CMS two months later. Payments would be gradually reduced over the course of three years in place of applying the new formula and coding modifications right away, and the most manipulable codes would likewise be phased out gradually.
The reimbursement rates for Medicare Advantage plans will increase by 3.3% in 2019, which is more than quadruple the initial 1% CMS suggested.
The contracts of plans with a poor track record are not threatened by a separate final rule on Medicare Advantage prior authorization rules, which can delay or deny required care and offer no public transparency on which plans rely on pre-authorization the most.
According to a National Bureau of Economic Research research, these behaviors are largely to blame for the thousands of insured seniors who pass away every year from a lack of access to healthcare.
A well-intentioned attempt to stop Medicare Advantage fraud and safeguard patient lives was intimidated by industry backlash.
But, those who have spent years challenging Medicare Advantage’s hegemony see it as a type of success. You might infer from that how influential this sector has historically been.
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