Medicare Advantage Plans Need Tougher Oversight, GAO Says

Federal investigators have found that Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care. It’s a problem many Connecticut seniors know too well. In 2013, UnitedHealthcare, the nation’s largest health insurance company, dropped hundreds of health care providers from its Connecticut Medicare Advantage plan, including 1,200 doctors at the Yale Medical Group and Yale-New Haven Hospital. Medicare Advantage beneficiaries scrambled to find new insurance or new doctors while the Fairfield and Hartford counties medical associations went to court to try to stop the terminations. The report by the Government Accountability Office, the investigative arm of Congress, said that Medicare did not check provider networks to ensure that doctors were available to beneficiaries and cited Connecticut as a “case study” in what can go wrong.

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Feds Issue Rules To Protect Seniors Enrolled In Medicare Advantage Plans

UnitedHealthcare’s decision last fall to drop thousands of doctors from its Medicare Advantage plans in Connecticut and across the country has spurred Medicare officials to improve protections for seniors who lose their doctors. The new measures were announced late Monday along with a slight increase in next year’s payment rates to Medicare Advantage insurers who provide policies as an alternative to the traditional government-run Medicare program. Nearly 16 million older Americans have enrolled in a Medicare Advantage plan, including more than 147,000 in Connecticut, which requires members to get treatment only from a network of health care providers. They cannot change plans during the year if their doctor leaves their network. The new rules require insurers to provide at least 90 days advance notice of significant changes in their provider networks and allow members to switch plans under certain circumstances.

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