National Public Radio (NPR) recently aired a piece about a recent report by the Government Accountability Office (GAO) regarding the number of senior enrollees dropping out of Medicare Advantage health plans. These plans are privately-run health care plans that enroll about one-third of Medicare enrollees, or about 19,000 patients. The goal of these plans is to keep costs down for enrollees by using cost-conscious networks of doctors and healthcare facilities. However, the GAO report questions whether these plans are leaving their sickest enrollees worse off than they were before.
In completing its report, the GAO reviewed 126 Medicare Advantage plans. Of those plans, the GAO found that 35 of those plans had disproportionately high rates of sicker seniors opting out of coverage. Twenty-four of those plans had one out of every five patients leave the plan in 2014, which is a much higher rate than usual. The main reason that seniors left the plans, according to the GAO, was the difficulties that they had in accessing preferred doctors, hospitals, and healthcare facilities. The sicker the seniors were, thus requiring more medical care, the more likely they were to drop out of the Medicare Advantage plans.
The GAO recommended that federal health officials strongly consider rejecting the plans in questions, stating that the high patient turnover rates for very sick patients was a sign of substandard care. A spokeswoman for the industry trade group America’s Health Insurance Plans, however, stated that the patient turnover was simply the result of a free marketplace, which enables patients to switch to cheaper and more inclusive plans as they wish.
The loss of Medicare advantage plans can be substantial, particularly as a senior citizen continues to decline in health. An inability to fund necessary care can result in individuals having inadequate care, whether it is by an in-home caregiver, assisted living facility, or other long-term care program, and makes them very vulnerable to abuse and neglect by caregivers. The community based residential facility (CBRF) lawyers of Boller & Vaughan are experienced in ensuring that nursing homes and other elderly care facilities live up to reasonable standards in caring for their residents. When a nursing home or other type of facility fails to do so, and injury to a resident occurs, the facility may be liable for those injuries. We know how to investigate your case, assess your situation and determine whether you or your loved one has any potential claims against nursing home staff or the nursing home itself. Contact Boller & Vaughan today and learn how we can help you through this difficult situation.