March 16, 2023

LeadingAge Paper: MA Plans Not Delivering on Promise to Consumers

BY Nicole Fallon

Nearly 30 million Medicare beneficiaries are now enrolled in Medicare Advantage (MA). As the MA program has grown, so have the problems with access and payment for post-acute care (PAC) services for older adults and PAC providers. LeadingAge members – skilled nursing facilities and home health agencies – have shared numerous examples of MA plans refusing to authorize medically necessary Medicare services that the person would have received if they had chosen to remain in the original Medicare program. MA plans are paid to cover and coordinate Medicare Part A & B services for Medicare beneficiaries who enroll in their plan; plans that are wrongfully denying care are breaking their promise to their enrollees. In response, LeadingAge published a white paper, entitled, “Fulfilling the Promise: Medicare Advantage.”

This paper articulates the breadth of challenges faced by MA enrollees when attempting to access their Medicare benefits through MA and by PAC providers in caring for these individuals. It also offers solutions to resolve these issues to support providers and ensure beneficiaries’ equitable access to needed PAC .

“We’re at a critical point as MA plans expand,” said Katie Smith Sloan, LeadingAge president and CEO, in the paper’s press announcement. “Our members’ experiences and challenges in serving older adults while dealing with myriad plan policies are at the heart of the Fulfilling the Promise report and the reason we’re intensifying our advocacy on these issues.  Medicare beneficiaries deserve to receive the care they need, and providers, who deliver it, deserve to be paid in predictable, fair, and straightforward ways. We can do better.” 

The paper lays out the issues and corresponding solutions in the following areas:

  • Making payment rates adequate and predictable
  • Understanding and addressing challenges with prior authorizations.
  • Bringing the vision of high-quality care closer to routine practice by making value-based arrangements workable.
  • Giving beneficiaries a true choice of high-quality providers by addressing network adequacy.
  • Addressing transparency concerns by improving data collection and sharing.
  • Actively supporting beneficiary needs and rights.

The time is now for policymakers to address these issues and make changes before these bad practices impact the broader health care system. LeadingAge members who want to advocate on these issues can join us at our Leadership Summit, April 17-19, 2023 in Washington DC.

Finally, LeadingAge is establishing a new member network on Managed Care Solutions. Members interested in participating should email Nicole Fallon to get added to the network. Once launched, more information on the Managed Care Solutions Network will be included on the LeadingAge Member Network Page, here.