5 Medicare Advantage updates

Medicare Advantage has been a divisive topic in the healthcare industry as of late, with some health systems cutting ties with certain insurers or with the program entirely.

Here are five updates on Medicare Advantage that ASC leaders should know, as reported by Becker's since Feb. 13:

1. Officials in New Hampshire intend to enact fines against Anthem Blue Cross Blue Shield for ongoing delays with mail-order prescriptions. The plan, owned by Elevance Health, took over the state's Medicare Advantage plan for retirees Jan. 1, with a contract stating the insurer must ship 98% of mail order prescriptions within two days. Since then, retirees have faced extended delays for delivery of mail-order medications and incorrect out-of-pocket charges for prescriptions. Officials said they intend to impose penalties specified in the contract, which could include canceling the partnership and quarterly fines of more than $50,000.

2. A survey by the Commonwealth Fund found that Medicare Advantage members are more likely to report delays in care than those covered by traditional Medicare. Twenty-two percent of Medicare Advantage members reported waiting to receive care while awaiting insurance approval compared to 13% with traditional Medicare.

3. Munster, Ind.-based Community Healthcare System plans to drop Humana and Aetna's Medicare Advantage plans June 1, citing unreasonable denials and delayed payments. 

4. A JAMA Health Forum study found Medicare Advantage enrollees received less intensive post-acute care than their counterparts in traditional Medicare, but did not have a significant change in short-term outcomes. 

5. Montgomery, Ala.-based Baptist Health is suing Humana, claiming the insurer's Medicare Advantage plan underpaid the hospital for drugs purchased through the 340B program. In the lawsuit, the system asks the payer to commit to reimburse the health system for the drugs at the higher payment rates CMS established after the Supreme Court ruled its cuts were illegal.

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