From the Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI (FB); Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYA).
J Am Board Fam Med. 2024 May-Jun;37(3):494-496. doi: 10.3122/jabfm.2023.230384R1.
The Medicare Advantage (MA) Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. Recent investigations conducted by the United States Senate Committee on Finance and Centers for Medicare & Medicaid Services (CMS) have uncovered marketing practices of MA insurance agents that "were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision." These findings come at a time in which MA programs are under investigation for denials of prior authorization requests that fall within Medicare guidelines for covered health services. In this Commentary we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.
医疗保险优势(MA)计划为近一半符合条件的 Medicare 参保人群提供服务,最近受到了更多的审查。美国参议院财政委员会和医疗保险和医疗补助服务中心(CMS)最近进行的调查发现,MA 保险代理人的营销行为“不符合现行法规,过度向受益人施压,而且没有提供准确或足够的信息来帮助受益人做出明智的参保决定”。这些调查结果是在 MA 计划因拒绝在 Medicare 规定的涵盖健康服务范围内的事先授权请求而受到调查之际得出的。在本评论中,我们将考虑 MA 计划受到更严格审查的背景及其对未来发展轨迹的影响。