LeadingAge Nebraska president and CEO Kierstin Reed testified on February 23 at a Senate Aging Committee field hearing, “Medicare & Medicare Advantage: Challenges and Opportunities with Enrollment,” on the complexities of the Medicare enrollment process and the confusion many beneficiaries face when they are denied coverage for post-acute and long-term care services, particularly in the Medicare Advantage (MA) space. The hearing was held in Omaha, Nebraska, by Senator Pete Ricketts (R-NE), whose family’s personal experience served as part of the hearing’s inspiration.

Reed testified alongside witnesses that included a Medicare applicant, a chief medical officer from Bryan Health, an associate state director with AARP Nebraska, and a revenue specialist with Nebraska Medicine.  All of the witnesses addressed various challenges with the Medicare system that covers approximately 65 million beneficiaries across the U.S., more than 300,000 of whom live in Nebraska.  However, the broad themes that emerged focused specifically on the problematic payment policies and deceptive marketing practices of MA plans.  More than 50% of beneficiaries nationally are enrolled in a MA option. For Nebraska, this is closer to 30%—and continues to rise.

“These plans entice beneficiaries with many benefits that are not available in the traditional Medicare model, however beneficiaries may find that these plans are not widely accepted at every medical provider, limiting their options for care. Beneficiaries may also find that the Medicare services they expect to receive are not the same through an Advantage plan as compared to traditional Medicare due to Advantage plan authorization denials and limitations of services,” Reed noted in her testimony.

The witnesses echoed Reed’s comments and spoke about the various impacts these problematic coverage and payment policies have had on patients and families. Health care providers routinely face challenges securing medically necessary services from MA plans, the most challenging of which include prior authorization requirements, reimbursement challenges, and inconsistent interpretation of Medicare rules.

The Medicare three-day minimum qualifying hospital stay requirement for skilled nursing facility coverage was also raised as a policy that needs to be reevaluated and repealed.  Although Medicare fee-for-services plans are bound by this policy, MA plans are not.

“We need to assure that beneficiaries are receiving equitable care, regardless of how they choose to receive their Medicare benefits,” Reed stated.