Hospitals across the United States are increasingly facing significant challenges with Medicare Advantage plans. According to reports, these issues primarily stem from slow payment times, frequent benefit denials, and the need to employ additional staff to manage appeals. This situation is creating a financial strain on healthcare facilities and impacting patient care.
Introduced in 1997 as Medicare Part C, Medicare Advantage plans offer lower premiums and some extra features, but generally have restricted provider networks. These plans replace traditional Medicare programs and are managed by for-profit health insurance companies rather than the federal government. Reimbursement rates are set in negotiations between the insurers and providers, not the Centers for Medicare and Medicaid Services (CMS).
In 2023, at least 15 hospitals and health systems dropped out of various insurers’ Medicare Advantage contracts. More than 60% of health systems are considering dropping Medicare Advantage coverage this year. Among the most cited reasons were excessive prior authorization denial rates and slow payments from insurers.
Furthermore, some insurance companies, despite high profits, are increasing premiums or discontinuing their Medicare Advantage plans in certain markets, forcing millions of people to find a new option for their healthcare.
Slow Payment Times
One of the most pressing challenges hospitals face with Medicare Advantage plans is slow payment times. According to a report from the American Hospital Association, payment delays can extend for months. This situation places a strain on hospital resources and can ultimately lead to cutbacks in services or even staff layoffs.
Benefit Denials
Benefit denials are another significant concern. Hospitals often find that claims submitted under Medicare Advantage plans are denied at a higher rate than those submitted under traditional Medicare, even for medically necessary procedures and treatments.
A study published by the Journal of the American Medical Association indicated that nearly one in five claims is denied by Medicare Advantage plans, necessitating time-consuming appeals processes. Another review found that hospitals experienced a 56% increase in payment denials from January 2022 to July 2023. These denials both hinder the financial stability of hospitals and delay necessary care for patients, thereby potentially leading to adverse health outcomes.
The Impact on Hospitals
In response to slow payments and the growing number of denied claims, many providers have been forced to hire additional staff specifically dedicated to reviewing claims, managing appeals, and negotiating with health insurance companies. This further strains hospital budgets, diverting resources away from direct patient care. According to a report from the Healthcare Financial Management Association, hospitals spend millions of dollars a year on the administrative costs associated with navigating the complexities of Medicare Advantage plan appeals.
This financial burden can lead to reduced services, layoffs, and even the closure of some hospital departments.
Given these challenges, many are seeking alternatives. One option gaining traction is Liberty HealthShare's Liberty Assist program, which offers a faith-based approach to healthcare costs.
Liberty Assist: An Affordable Alternative
Liberty Assist is for people 65 and older who are enrolled in Medicare Parts A and B. It can help fill the gaps in their medical coverage and aid in controlling medical expenses.
The program allows members to use any doctor or hospital that accepts Medicare and has no pre-existing condition limitations, providing greater flexibility and peace of mind.
Liberty Assist offers several features that make it an attractive option for seniors. It includes access to dental, vision, prescription, and telehealth discounts, which are not typically covered by Medicare or other medical cost sharing organizations. This comprehensive coverage helps seniors manage their healthcare costs more effectively.
Moreover, Liberty HealthShare is a Christian healthcare sharing ministry, which means members are part of a community of like-minded individuals who share similar values. This sense of community can provide emotional and spiritual support, which is lacking in insurance plans.
The program is also cost-effective. Monthly contributions start at just $87, making it an affordable option for retirees on a fixed income. New member enrollment is available 3 months prior, 3 months after, or during the month a senior turns 65.
The Benefits of a Community-Oriented Approach
Being part of a healthsharing ministry like Liberty HealthShare comes with its own advantages. Members often feel a strong sense of community and shared purpose, which can enhance their overall healthcare experience. The transparency in costs and the shared responsibility among members can lead to lower healthcare expenses, allowing individuals to manage their health without the financial burden associated with medical insurance plans.
As providers continue to review the complexities of Medicare Advantage plans, patients should review all their options. Alternatives like Liberty HealthShare's Liberty Assist program offer an affordable alternative that not only shares into essential healthcare needs but also fosters a supportive community and promotes Christian values.
