Jensen: Medicare Advantage isn’t worth the promised perks

Neal Jensen

Submitted photo

The enticing perks offered by Medicare Advantage plans can come at a significant cost, particularly when you need care the most.

There is no such thing as a free lunch — those extra benefits come at a price. To provide them, costs must be cut somewhere else. At Cobre Valley Regional Medical Center in Globe, we witness daily how Medicare Advantage plans employ tactics to delay or deny necessary treatment.  

These delays primarily target local physicians or hospitals, who work tirelessly to ensure that patients receive the care they need and deserve. Unfortunately, Medicare Advantage plans prioritize increasing corporate profits by denying/delaying care. These delays/denials come in many frustrating forms such as: 

1) Denial of records that have already been provided

2) Denials by creating unnecessary system complexity

3) Denials by not adding your provider to their network

4) Delays or denials for life-saving drugs

5) Denials for basic services that were easily accessed with traditional Medicare

Medicare is federal health insurance that is available to people 65 or older and some under 65 with qualifying disabilities or health conditions. It is something many of us pay taxes on every year we are employed so that, later in life, we may have health insurance. This insurance is a critical lifeline for those who rely on low to no rates in their retirement years, or during times of health uncertainty due to a disability.

The problem is, we are seeing our Medicare Advantage patients being taken for a ride. They believe they are covered but instead see denials and delays for medically necessary treatment.

Medicare Advantage promotes itself to offer coverage for things that traditional Medicare doesn’t cover. The truth is, Medicare Advantage typically offers a more narrow network of providers from which to choose whereas traditional Medicare allows you to see any doctor who accepts Medicare. Medicare Advantage plans often require prior authorizations which can delay care or even cause it to be denied.

A 2022 report by the U.S. Department of Health and Human Services Office of Inspector General found Medicare Advantage organizations denied prior authorization requests and payment for services that would have been covered by traditional Medicare. This can leave Medicare Advantage members spending more than they need to on hidden costs and denied coverage.

Medicare Open Enrollment began Oct. 15 and will run through Dec. 17 this year. It is important that seniors fully understand their options when it comes to federal health insurance and understand what they may be giving up by selecting Medicare Advantage instead of traditional Medicare.

Putting elderly and disabled residents at risk of getting the coverage they need for medically necessary health care should not be an option. We are here to care for you when you need us. Make sure your federal health insurance is ready to care for what you need when you need it.

Editor’s note: Neal Jensen is the CEO of Cobre Valley Regional Medical Center in Globe. Reader reactions, pro or con, are welcomed at AzOpinions@iniusa.org.