Medicare Advantage: It’s complicated

YARMOUTH, Maine – Medicare Advantage plans have exploded in popularity, but many HME providers have a love/hate relationship with them. 

Eighty-seven percent of respondents to a recent HME Newspoll say they’ve seen an increase in the number of insurers offering MA plans in the past year, and 90% say they’ve seen an increase in the number of patients with such a plan in the past year. 

“I feel like we have more volume; however, that always comes with a caveat,” wrote Josh Carroll, director of reimbursements at Liberty Medical Specialties. “They typically want to reimburse at a percentage of Medicare, so lower reimbursements. And they take longer to pay than Medicare. I'm not a fan, but you have to learn to adapt in this ever-changing environment, if you wish to be/stay competitive.” 

The majority of respondents, 54%, say they serve six or more MA plans. 

In addition to lower reimbursements, respondents cite increased paperwork requirements as another challenge with MA plans. 

“It has impacted business negatively,” wrote one respondent. “The approvals process is cumbersome and generally we experience a higher number of claim denials.” 

And that’s when providers know what the requirements are, respondents say. 

“MA plans tend to make up their own coverage criteria,” wrote on respondent. “Some are more restrictive than Medicare, some less. All the while, the reps say ‘Yes, we go by Medicare's guidelines.’” 

Providers also have to grapple with confusion around MA plans, especially as insurers ramp up marketing of these plans to seniors, including with TV commercials, respondents say. 

“The plans sound better to the customers, but many pay below traditional Medicare and several of the newer plans do not have co-pays or deductibles,” wrote Carolyn Francisco, DME AR/billing manager, Northern Pharmacy & Medical Equipment in Baltimore. “We have found that these plans will not cover our cost of products.” 

But providers ignore the MA market at their peril, some respondents say. 

“To stay successful in this business you need to service Advantage plans,” wrote Brent Squires, LPED, ORF, Access Health Care Physicians Spring Hill, Fla. “More plans means more patients.”