Due to recent disputes between Medicare Advantage carriers and Nebraska hospitals, some hospitals in the state are no longer accepting Medicare Advantage patients.
However, Saline and Seward county hospitals, including Crete Area Medical Center, Friend Community Healthcare System and Seward Memorial Hospital, are continuing to do so.
Seniors, especially those with complex medical needs, cannot afford to have their healthcare access interrupted, so Jessica Brooks-Woods, CEO of the National Association of Benefits and Insurance Professional, said it is imperative that the Medicare Advantage dispute at the hospitals that no longer offer the plans is resolved in a way that ensures continuity of care.
“The well-being of Nebraska seniors is at stake,” she said in a press release. “NABIP and our members, who work tirelessly to help seniors navigate their healthcare options, urge all parties to act quickly and collaboratively to protect access to vital healthcare services.”
The Nebraska Rural Health Association recognizes that Medicare Advantage plans create financial stress for rural hospitals. The NRHA said the plans typically reimburse at lower rates than traditional Medicare, create higher administrative costs due to treatment denials and do not recognize the critical access hospital model for cost reimbursement.
This means the plans pay less, cost more and treat rural hospitals the same as large urban academic hospitals.
Seward Memorial Hospital CEO Roger Reamer said SMH offers a few Medicare Advantage programs in addition to traditional Medicare so community members can have a choice. The hospital puts out a campaign at the start of Medicare enrollment periods to ensure the community understands which plans it works with.
“It’s important that we try to offer both,” Reamer said. “We’re not offering every Medicare Advantage plan. We’re making sure we’re offering the ones that we think are the best ones to be in so that the community does have a choice if they have different reasons as to why they are with original or Medicare Advantage.”
Reamer said SMH also tries to educate patients on the difference between the types of Medicare so they can make informed decisions. Medicare Advantage is a Medicare-approved plan offered by a private company that covers some services or goods that traditional Medicare may not.
Medicare Advantage also often has lower premiums.
Although Medicare Advantage is often cheaper in the beginning, people’s care could be denied if the plan does not cover it or it could be delayed due to prior authorization steps, Reamer said. Additionally, the hospital has to put more time and resources into processing claims through Medicare Advantage plans because of the hoops it has to jump through when working with prior authorization and managing denials for payments or slow payments.
“Probably the biggest thing we’re trying to do is make sure that people understand if they’re going to go with that Medicare Advantage plan, they know that their experience is going to be a little different than if they were with the original Medicare,” he said.
Crete Area Medical Center signed on 27 new Medicare Advantage plans this year that will be available starting in 2025. Lola Hildebrand, team lead for the CAMC billing department, said the plans are beneficial because they are more affordable for patients and reimbursable for the hospital.
Friend Community Healthcare System CEO Jared Chaffin said Medicare Advantage can be a conundrum to deal with because the programs are quick to deny claims and it is difficult to get pre-authorization for patients.
However, FCHS feels it is important to offer Medicare Advantage because many patients use it.
“As difficult as (Medicare Advantage plans) are to deal with, if hospitals stop offering it, that’s really going to put out a lot of patients,” Chaffin said.
Reamer said although Medicare Advantage can present challenges for hospitals and clinics, SMH is more concerned about helping patients understand the challenges they may face with the plans and make the best decisions for themselves.
Every patient is different, and the hospitals in Seward, Friend and Crete are making it a priority to continue offering Medicare Advantage so they can care for as many people as possible.
