As Seniors Get Sicker, They’re More Likely To Drop Medicare Advantage Plans – NPR

A GAO report questions the quality of a number of Medicare Advantage plans after large numbers of sicker enrollees dropped them.

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A GAO report questions the quality of a number of Medicare Advantage plans after large numbers of sicker enrollees dropped them.

Yellow Dog Productions/Getty Images

When Sol Shipotow enrolled in a new Medicare Advantage health plan earlier this year, he expected to keep the doctor who treats his serious eye condition.

“That turned out not to be so,” said Shipotow, 83, who lives in Bensalem, Pa.

Shipotow said he had to scramble to get back on a health plan he could afford and that his longtime eye specialist would accept. “You have to really understand your policy,” he said. “I thought it was the same coverage.”

Boosters say that privately-run Medicare Advantage plans, which enroll about one-third of all people eligible for Medicare, offer good value. They strive to keep patients healthy by coordinating their medical care through cost-conscious networks of doctors and hospitals.

But some critics argue the plans can prove risky for seniors in poor or declining health, or those like Shipotow who need to see specialists, because they often face hurdles getting access.

A recent report by the Government Accountability Office, the auditing arm of Congress, adds new weight to criticisms that some health plans may leave sicker patients worse off.

The GAO report, released this spring, reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to “preferred doctors and hospitals” or other medical care as the leading reasons for leaving.

“People who are sicker are much more likely to leave [Medicare Advantage plans] than people who are healthier,”James Cosgrove, director of the GAO’s health care analysis, said in explaining the research.

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