Home Health Care Industry Impacting Solvency of Medicare

By January 1, 2023, Medicare Advantage had reached 52% of Medicare eligibles. This program has become an overwhelming success. Like anything new and revolutionary, there have been bumps in the road, but the popularity of this program in insurance carriers (also known as Plan Sponsors), the Third Party Marketing Organization and Agents and Brokers community, and the beneficiaries themselves is undeniable at this point. Still, mis or under informed viral videos and Social Media posts plague the World Wide Web stating cognitively-numb points and flat out lies trying to get some people to leave their Medicare Advantage Plan.

Uncovering the Facts

Here are the facts: After finding 47 posts each representing thousands if not tens of thousands of likes, comments and shares on TikTok, YouTube and probably most notably, Facebook, we identified 36 of them written or created by a Home Health Care nurse. In many instances a Home Health Care Nurse is an LPN. An LPN is an honorable achievement, but certainly not a representation of the opinion of the entire Medical community on the Federally created Medicare program that aims to rescue Medicare from the impending doom that is its solvency crisis.

The Baby Boomer generation has flooded the Medicare program with beneficiaries that are rapidly increasing the rate at which the Medicare trust fund is depleting its reserves. This has been foreseen for some time, and though the idea that the population increasing and thus working members of society would increase at a rate that would pay more taxes and sustain the program exists, we as a nation are finding that is not the case. So, Medicare Advantage was created to allow Private companies to develop Medicare plans that cover at minimum the same services that Parts A and B of Medicare cover. The idea is that a private company using capitalistic economics can be more efficient than the Federal government with identifying Fraud, Waste and Abuse within claims.

Home Health Care’s Role in the Debate

I have talked to people that owned Home Health Care businesses prior to Medicare Advantage that bragged about how much money they were making back then. It is no wonder that this industry is indoctrinated to hate the program. It seems that Home Health Care perhaps disproportionately benefited from the asleep at the wheel claims approval processes of Traditional Medicare. Now, being held to a standard of proving that a beneficiary indeed needs Home Health Care at the expense of the taxpayer, they must be finding that getting the approval is harder than before.

Addressing the Prior Authorization Issue

Congress has recently asked Medicare Advantage Plan Sponsors (the carriers like Humana, UnitedHealthcare, Aetna, etc) to reduce the amount of Prior Authorization requests they’re sending to providers. Most carriers have made a commitment to reduce these by over 20% in 2024. I am by no means saying that prior authorization requirements are frictionless. However, the fact that one small sector of the vast healthcare industry is the main perpetuator of the viral Medicare misinformation screams to me that something is amiss. It is relevant to note that the Medicare Advantage beneficiary satisfaction was considered good to great as reported by JD Power.

Tailoring Medicare to Individual Needs

The thing about Medicare is, everyone has different needs and expectations. It is similar to political opinions. Celebrities in Hollywood might have the luxury of viewing things differently than a blue collar coal mining or first responder heavy family. Half of my family were carpenters and the other half were telephone linemen. I have written plans on my parents, grandparents and many aunts and uncles. I’m about 50/50 on placing them in Traditional Medicare with a Medigap Plan F, G or N and a Medicare Advantage Plan. The satisfaction of Medigap is high, but unfortunately for some the premium can become cumbersome as they age and Medicare Advantage becomes a great alternative.

Choosing the Right Medicare Plan

Agents and Brokers of course can have bias considering they’re paid a commission to enroll, but if you find an experienced broker that has a highly organic book of business through local word of mouth or organic Google Search, you’ll likely find that the plan they help you pick has little to do with its commission level. Good and bad agents advertise or source qualified prospects in different ways, but you can help qualify them by asking three simple questions:

• Will you help me enroll in a Medigap or Medicare Advantage Plan, whichever I choose?
• Are there any companies or plans in my area you do not represent, and why?
• Have you enrolled people in both Medigap and Medicare Advantage plans, and about how many of each have you done?

Also, you can cut out all of the jargon and just call Bobby Brock Insurance for help. We have helped tens of thousands of people nationwide right from our offices in North Mississippi. We use sophisticated software and the treat others as you would wish to be treated mentality to advise our clients year after year. Thank you for reading this article, and please feel free to share on social media to combat misinformation.