Managing Medicare Advantage Denials of Coverage and Appeals
Today, nearly 16 million seniors and people with disabilities are enrolled in an MA plan, representing 30 percent of the Medicare population. Many people with MA plans have a positive experience and report a favorable experience with their plan. Yet, we find that managing denials of coverage and appeals remains a consistent concern for MA enrollees, such as in Mr. W’s experience.
In 2013, we fielded over 15,000 questions from Medicare beneficiaries, family caregivers, and professionals. Many of our callers, like the one whose story is detailed in this brief, struggle to navigate the complexities of the Medicare Advantage system, secure coverage for needed services, and afford out-of-pocket health care costs.
Any changes to the Medicare program must aim for healthier people, better care, and smarter spending—not paying more for less. As policymakers debate the future of health care, we will provide our insights here.
Thinking ahead to Medicare's future, it’s important to modernize benefits and pursue changes that improve how people with Medicare navigate their coverage on a daily basis. Here are our evolving 30 policy goals for Medicare’s future.
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