Coronavirus Shows Us Why Corporate Health Insurance Is a Problem

✑ DIANE ARCHER` ╱ ± 6 minutes
All constraints on access to care remain in place.

The federal government should require that Medicare Advantage plans cover the full cost of coronavirus treatment. But it has not done so.

Diane Archer is a senior adviser to Social Security Works and founder and president of Just Care USA, an independent digital hub covering health and financial issues facing boomers and their families and promoting policy solutions. She is the past board chair of Consumer Reports and serves on the Brown University School of Public Health Advisory Board. Ms. Archer began her career in health advocacy in 1989 as founder and president of the Medicare Rights Center, a national organization dedicated to ensuring that older and disabled Americans get the health care they need. She served as director, Health Care for All Project, Institute for America’s Future, between 2005 and 2010.

Tens of thousands of Americans are now sick from the novel coronavirus. Hundreds have already died. Swift testing and treatment are essential to protect the health of Americans, particularly older adults and people with disabilities, who are most at risk. But Medicare Advantage plans—health plans run by corporate health insurers to deliver Medicare benefits—continue to impose financial and procedural obstacles to coronavirus treatment, threatening the public health.

Consequently, we can assume that many of the 24 million Americans with Medicare Advantage plans aren’t able to access testing, let alone treatment, and are infecting others. As is the case for at least one in four people with corporate health insurance, high out-of-pocket costs lead older adults in Medicare Advantage plans to skip or delay treatment.

Medicare Advantage plans have never released data on actual out-of-pocket costs for people with different medical conditions. But, by law, these costs can be as high as $6,700 a year for in-network care alone and unlimited for out-of-network care. In 2016, 30 million people with Medicare had annual incomes below $26,200 , and 15 million had incomes below $15,250.

The federal government should require that Medicare Advantage plans cover the full cost of coronavirus treatment. But it has not done so. Rather, the Centers for Medicare and Medicaid Services has only issued “guidance” to these private plans, suggesting that they waive the costs of treatment and eliminate other barriers to care, including prior authorization requirements. That guidance appears to have fallen on deaf ears.

To its credit, on March 10, CMS issued a directive to Medicare Advantage plans to cover care their members receive for coronavirus testing and treatment at out-of-network facilities that participate in Medicare at the same cost as at in-patient facilities. Medicare Advantage plans must also waive any requirements that their members get referrals in order for their care to be covered. These are steps in the right direction, if implemented.

The Medicare Advantage plans, however, do not appear to be making these changes to their rules, much less waiving all treatment costs. The coronavirus web pages for United Healthcare and Humana, the two largest Medicare Advantage plans in the U.S., don’t let their members know that they are covered for coronavirus care at out-of-network facilities without referrals.

Indeed, they suggest that all constraints on access to care (including prior authorization requirements, narrow provider networks, deductibles, and copays) remain in place. Of course, that’s how insurers deter people from getting care and deliver the greatest profits to their shareholders. The bottom line comes first .

The online information that United Healthcare and Humana are providing their members regarding coverage is problematic at best. As of March 26, United Healthcare’s coronavirus web page simply says that the coronavirus “test—and visits related to testing—are covered by UnitedHealthcare at approved locations for insured Medicaid and Medicare members.” You need to scroll down and click on a link to see that testing is covered in full. And, there is no link to a list of approved locations.
No matter how dire the situation, corporate health insurers will always put their profits first.
United Healthcare also states that deductibles, coinsurance and copays for people needing treatment will apply. It does not tell people that coronavirus care at out-of-network facilities is covered at the same cost as at in-network facilities, without a referral. United Healthcare has 70 million members overall and covers 25 percent of Medicare Advantage members .

As of March 26, Humana’s coronavirus web page is also silent on out-of-pocket costs for treatment and on the fact that their members can get coronavirus care at out-of-network facilities at no additional cost. Humana covers 17 percent of Medicare Advantage members.

None of this comes as a surprise. For years, Medicare Advantage plans have overbilled the federal government to the tune of tens of billions of dollars , engaged in widespread inappropriate delays and denials of care , threatened the health and safety of their members, and more .

There are two important lessons here. First, no matter how dire the situation, corporate health insurers will always put their profits first ; they will maintain financial and procedural barriers to care and fail to disclose information that encourages people to get treatment, jeopardizing the health of their high-risk enrollees. Second, if we want to ensure Americans get needed care, the federal government must pay for testing and treatment.

We know that our health care system is broken. Lawmakers have believed that we can fix it by relying on corporate health insurers, even for people with Medicare. But, the practices of Medicare Advantage plans during the coronavirus pandemic make one thing clear: corporate health insurers should not be entrusted with looking out for the health and well-being of Americans.

This article was produced by Economy for all, a project of the Independent Media Institute.

Top image: State Public Health Laboratory in Exton Tests for COVID-19, March 6, 2020. From: flickr.


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