Medicare Advantage Plans Often Deny Seniors Access to Special Care, Analysis Shows

Key Points:

• Federal investigators found that private Medicare Advantage plans have inappropriately denied admission to skilled nursing facilities for patients discharged from hospitals, impacting recovery care for millions of older Americans.
• These plans, covering about 35 million people, often require prior authorization and have financial incentives to limit expensive inpatient care, leading to denials of specialized rehabilitation and therapy services.
• Reports from the Department of Health and Human Services’ inspector general highlight major insurers like UnitedHealth Group, Humana, and CVS Health, revealing they denied approximately 13% of requests for skilled nursing facility care after surgery or serious illness.
• Concerns were also raised about the oversight of outside contractors used by insurers to make decisions on patient care authorization, potentially affecting the quality and appropriateness of care provided.
• The concentration of Medicare Advantage coverage among a few large companies means their policies significantly influence care access for millions of beneficiaries.