September 11, 2023
Payers | Tea Leaves
  • Most Medicare Advantage (MA) beneficiaries are satisfied with their health plan, but many enrollees feel they are overbilled, have struggled to navigate the prior authorization process, or are confused by the features of their plan, a new survey from Retirement Living recently revealed. The survey found that 71 percent of beneficiaries are satisfied with their MA plan, with most people choosing a MA plan due to the plan’s affordable costs and out-of-pocket expenses. However, only 44 percent of MA enrollees say they fully understand their plan, with 68 percent saying certain details have caused confusion. Dental coverage was the most reported area of confusion, followed by out-of-pocket costs, transportation to medical appointments, caregiver support services, home health services, and vision and hearing coverage. At least 20 percent of beneficiaries said they didn’t understand one or more of these plan elements. (Article here)
  • Health insurers are failing to adequately inform consumers about preventive services they are entitled to receive at no additional cost, according to a new report from consumer representatives to the national trade group for state insurance regulators. The consumer representatives to the National Association of Insurance Commissioners examined information from six plans in six states about their coverage of smoking cessation, HIV prevention medication, colorectal cancer screening, and postpartum depression screening. They found that documents available to consumers tended to have missing or inconsistent information about preventive services coverage. They also said that drug formularies were difficult to navigate and didn’t always note when preventive medicine was covered without cost-sharing. Additionally, guidance to providers about how to code preventive services wasn’t uniform across plans, proved difficult to locate, and was often incomplete. (Article here)