Medicare Advantage: A growing risk to Nebraska's rural health care

Medicare enrollment period begins on Oct. 15, extending through Dec. 7th.

Throughout this time, seniors across Greater Nebraska will receive numerous calls and letters urging them to switch to Medicare Advantage plans. While these plans often promote cost savings and added perks, the reality for patients and health care providers can be much different.

Patients face delays and higher costs

Unlike traditional Medicare, Medicare Advantage plans often require prior approval for care. In fact, nearly all Medicare Advantage enrollees must get prior authorization for higher cost services. Examples include needing your plan’s approval before receiving a prescription, physical therapy, lab tests, or worse, before a critical hospital stay or chemotherapy.

These delays can be detrimental. A recent study by the University of Washington showed that Medicare Advantage patients had worse functional health outcomes than patients with traditional Medicare. Meaning seniors switching to such plans were more likely to experience reduced independent living and require extra care from their family.

In 2024, the average out-of-pocket maximum costs for Medicare Advantage enrollees will reach almost $9,000 for in-network care and can exceed $13,000 out-of-network. These costs will almost certainly continue to increase. For rural Nebraskans, whose health care needs tend to grow as they age, these expenses can quickly accumulate. As a result, many rural clinics and hospitals are seeing increased requests for medical debt charity from Medicare Advantage enrollees.

Limited access to providers

Medicare Advantage plans often have limited provider networks, which means your current physician or the local specialist may not be included. In fact, about one-third of Nebraska’s hospitals and clinics have stopped accepting certain Medicare Advantage plans completely.

Just this year, Great Plains Health in North Platte announced it will no longer be in-network for any Medicare Advantage plan. Beginning in 2025, the hospital will stop scheduling visits for Medicare Advantage patients, including patients that were previously seen as out-of-network. Medicare Advantage patients in the area wishing to keep their doctor will need to switch back to traditional Medicare during open enrollment to continue receiving routine care in their community.

The threat to rural health systems

More than 700 rural hospitals across the U.S. are at risk of closure and Nebraska’s health care system is not immune. One factor in this crisis is the erosion of the critical access hospital model, which was designed to preserve rural health care through cost-based reimbursements. However, Medicare Advantage often offers inadequate payments, while adding the burden of prior authorizations, delayed and reduced reimbursements.

In Nebraska, 68% of hospitals are designated as critical access and all report that the rise of Medicare Advantage will harm their financial stability. Decisions by hospitals to leave Medicare Advantage networks aren’t about restricting choice, they’re about survival.

Rural hospitals are the backbone of Nebraska’s communities, providing essential care and driving local economies. They offer good-paying jobs, purchase goods and services locally, and serve as critical lifelines for Nebraskans. Our health care teams should not have to choose between financial survival and delivering necessary care.

Recommendations for seniors

To raise awareness of these challenges, the Nebraska Rural Health Association and Nebraska Hospital Association have teamed up with other local health care leaders to ensure seniors make informed decisions about their Medicare options. Over the past three years, this coalition has worked with Nebraska State Health Insurance Assistance Program to provide Medicare education to rural seniors, reaching 14 communities across the state last year alone.

Ask the following questions before switching.

• Are my doctor and local hospital in-network with this Medicare Advantage plan?

• What added services will I receive with Medicare Advantage? And what services do I currently receive that will no longer be covered?

• If I decide to switch back to traditional Medicare, will my costs be higher, and can I be denied supplemental coverage?

Seek assistance.

Reach out to the Nebraska State Health Insurance Assistance Program for help. The program offers free unbiased one-on-one meetings and community sessions on the differences between Medicare Advantage and traditional Medicare. The phone number is 800-234-7119.

The need for reform

As Nebraskans consider Medicare options this year, it is important to remember the decisions made now can affect your health, your finances and access to quality care for years to come. While Medicare Advantage may seem attractive, it often fails to deliver the care seniors need when they face serious health challenges, leaving individuals with higher costs, denied claims and limited access to care.

Nebraskans deserve strong health care, strong hospital, and an insurance system that works for them — not against them.

Jed Hansen is executive director of the Nebraska Rural Health Association and serves as the Nebraska Hospital Association’s senior rural consultant. He grew up in Minden. His academic background is focused on health care utilization facilitators and barriers in ambulatory care settings, and he actively practices in urgent care and emergency departments. Hansen is a fellow of the National Rural Health Association and the 2023 NRHA Advocate of the Year.