The sickest patients are fleeing private medicare plans—costing taxpayers billions
Subscribe to enjoy similar stories. Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home. The 85-year-old was so weak and fragile, her son said, that she couldn’t even get herself out of bed.
Her family felt she wasn’t ready to leave the facility in New York City’s Queens borough. So she dropped her UnitedHealth coverage and enrolled in the traditional version of Medicare run directly by the federal government. That decision saved UnitedHealth tens of thousands of dollars in the months that followed, billing records show, and shifted onto taxpayers the cost of later hospital and nursing home care in what turned out to be the final months of her life.
A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage’s sickest patients dropping their privately run coverage just as their health needs soared. Many, like Greene, made the switch after running into problems getting their care covered. Plans run by the private insurers in the Medicare Advantage system are supposed to offer old and disabled people the same benefits they would get from traditional Medicare.
The plans can be a bargain for people because they limit out-of-pocket expenses and often offer extra benefits such as dental care. As recipients get sicker, though, they may have more difficulty accessing services than people with traditional Medicare. That’s because the insurers actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use.
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