The Crystal Ball

Medicare Advantage plans are the most popular way for seniors to get Medicare benefits that exceed Original Medicare. And that may be the problem.

There is a far-reaching trend in which several hospitals are no longer accepting Medicare Advantage clients because they are not getting paid or the plans delay payment. This trend picked up in 2023 and continues today.

I suspect the problem is far-reaching, meaning that the issue is not paying the hospital but a more basic need like remaining profitable. The issue as I see it is these plans are competing for clients and the best way to attract new business is by offering ancillary benefits that will attract new clients. Things like grocery cards, and pre-paid debit cards are among the most popular new benefits. Add gym membership, over-the-counter drug benefits, etc., which attract new members. These benefits are not free, and the insurer must pay for these services. MAPD plans are slowing payments to providers and hospitals and you have an untenable situation that needs addressing.

Here in Southern Nevada, we have 84 plans. Do we really need that many plans? I don’t think so. Several new insurance carriers have entered our market in the past few years and are following the trend and are offering many more ancillary benefits to attract new clients. That trend continues whether it’s your typical MAPD plan or a special needs plan. These special needs plans are offering more benefits to attract dual needs clients who have both Medicare and Medicaid. Some of these plans are so rich in benefits that it’s almost like they are buying the business instead of earning it. While I think these plans are great for the Medicare recipient, I don’t think it’s great for the company. A new Medicare MAPD company entered the market a couple of years ago and offered benefits that exceed most plans. They got many new clients but not enough to turn a profit. That is the trend that needs addressing. I would prefer CMS not to get involved (although I know they will) because I have not seen any good coming from CMS when it comes to making intelligent decisions about Medicare, the brokers, or the plans. Their approach to problem solving needs some help and soon.

In Conclusion

To sum up this short blog, MAPD plans could have issues if they are not addressed soon. I hope they heed the message and do something. We need these MAPD plans for seniors.

I hope this information is useful. If anyone has questions, please contact me via phone or email, and I will respond quickly.

Also, if you need Medicare information, take a look at Medicare 2024 Information.

The Barend Agency Inc.

Len Barend, Broker

Cell:702-250-2200
Email: len@insurance4unevada.com