‘Buyer beware.’ Sen. Blumenthal warns seniors about Medicare Advantage plans

Advantage plans promise to cover more services than Medicare alone, but a new report says carriers are denying patients critical rehab care. Insurers call the claims “misleading.”

John Craven

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Oct 17, 2024, 9:32 PM

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Updated 36 days ago

If you turn on your TV, the ads are hard to miss.

“I already have Medicare,” a retired woman named Martha says. “Where are my extra benefits?”

Right now, the airwaves are flooded with Medicare Advantage plans promising you bigger benefits at a lower cost. But a new report from Sen. Richard Blumenthal released Thursday says the nation’s largest Medicare Advantage carriers are putting profits over patients’ needs.

The insurance industry said the report “cherry picked” data to “paint a misleading picture.”

DENIED CARE

After a long career teaching physics at the University of Connecticut, Gary Bent was supposed to grow old with his wife. “He was my spouse and best friend for 56 years,” said Gloria Bent.

Instead, Gary got cancer and a brain lesion. His doctors recommended a long-term acute care center, but Gary’s Medicare Advantage carrier would only pay for a short-term rehab facility.

“When he came home, he didn’t know where he was. He wasn’t sure who we were. He was running a fever. We discovered the next morning that he had bacterial meningitis,” Gloria said. “He lost all of the skills he had reacquired in rehab, and we brought him home. And my daughters and I cared for him until he died.”

“BUYER BEWARE”

Gloria Bent’s case is not unique.

“My message to Connecticut is buyer beware,” Blumenthal told reporters at a Thursday news conference.

According to a new report from Blumenthal’s Senate Permanent Subcommittee on Investigations, in 2022 United HealthCare and CVS denied post-acute care claims three times more than other services. Humana denied them 16 times more, the report found. The study looked at four years and 280,000 pages of data and documents obtained from the three companies.

The report says plans are increasingly using Artificial Intelligence to deny claims.

“It is insurers who are using prior authorization to protect billions in profits while forcing vulnerable patients into impossible choices,” the report states.

In a May 2019 presentation, CVS determined the move had saved more than $660 million in one year, according to the report.

INSURERS: REPORT IS “MISLEADING”

The insurance industry said the report is misleading and that most seniors are happy with their coverage.

Statement from the trade group America’s Health Insurance Plans:

“More than 33 million seniors and people with disabilities choose Medicare Advantage for their health coverage because it provides them better care at a lower cost than fee-for-service Medicare. This partisan report cherry picks anecdotes to paint a misleading picture of the Medicare Advantage program that is decisively outperforming fee-for-service on what matters most to seniors: affordability, access, benefits and outcomes. If seniors’ actual experience was anything like what is portrayed in these agenda-driven reports, seniors would leave Medicare Advantage in droves – and in fact the opposite is happening."

Statement from CVS:

"The report significantly misrepresents CVS Health's use of prior authorization. Many of the documents cited are outdated, while others are drafts or were used for internal Company deliberations and therefore are not reflective of final decisions. Our Medicare Advantage prior authorization protocols are routinely audited by the Centers for Medicare & Medicaid Services and we recently received a perfect score on an audit examining compliance with the 2024 Final Rule policies. We provided extensive feedback to the committee on these errors, which unfortunately were not addressed in the final report."

Statement from UnitedHealthcare:

“This majority staff report mischaracterizes the Medicare Advantage program and our clinical practices, while ignoring CMS criteria demanding greater scrutiny around post-acute care. Compared to beneficiaries enrolled in Original Medicare, Medicare Advantage members experience 45% lower out-of-pocket costs and have more than a 40% lower rate of avoidable hospitalizations and report a 96% satisfaction rating - all at a lower cost to the Government.”

Statement from Humana:

“This is a partisan report laden with errors and misleading claims. In fact, Senator Blumenthal’s team declined to correct those errors and mischaracterizations that Humana identified after reviewing certain heavily redacted excerpts prior to the report’s release.”

Blumenthal said the insurance industry isn’t being honest.

“It’s their data. It's their internal documents. It's their information that we're relying on here,” he said. “If they've got better information, they should give it to us.”

ADVICE FOR SENIORS

Senior advocates say Advantage plans can be a good option, but you should ask an important question first.

“I want you to give me a list of all the services that you subject to prior authorization,” said Sheldon Toubman, an attorney with Disability Rights CT.

Remember, traditional Medicare does not require prior authorization, but it also doesn’t cover certain services. Toubman said to also ask which doctors are in network.

Gloria Bent believes her husband might still be alive if insurance had let him stay in a rehab facility.

“How do you do this? How can you sleep at night?” asked Gloria Bent. “Is this what you would want for your parents?”