Medicare Advantage Plans and Prior Authorization

What you should know

On October 17th, DRCT hosted a press conference with U.S. Senator Blumenthal. He unveiled a report from the U.S. Senate Permanent Subcommittee on Investigations. The report is about insurance companies that provide Medicare benefits to older adults and people with disabilities. These benefits are provided under a Medicare program called "Medicare Advantage." The Medicare Advantage plans often use aggressive prior authorization before the insured individual can receive certain benefits.

The Senator said that data from three of the largest companies running these plans, United Healthcare, Humana and CVS, showed very high rates of denial of prior authorization, particularly for sub-acute rehabilitative services. These services are often critical for people recovering from a stroke or other medical condition.

The widow of a man who lost access to needed services from a Medicare Advantage plan also spoke at the press conference. The man had a medical crisis upon being involuntarily discharged from a nursing facility due to the plan’s termination of benefits and died as a result.

DRCT Litigation Attorney Sheldon Toubman also spoke at the press conference. He talked about how these Medicare Advantage plans use misleading ads to get people to sign up. After signing up, they then face hurdles that don't exist under traditional Medicare. People aren't warned about this in the ads.

'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."