Area medical center joins ranks of hospitals skeptical of Medicare Advantage

Medicare is health insurance that is federally provided for patients 65 or older. Medicare Advantage provides similar services but through private insurance companies.

There’s evidence that there is a potential incentive for Medicare Advantage agencies to increase profits by denying payment or access to services, according to a review done by the Office of the Inspector General within the U.S. Department of Health and Human Service.

“They are delaying any action on reimbursement,” Cameron Regional CEO Joe Abrutz said. “And you would think in this inflationary environment that we’re in now, especially with the American hospital, that we would get some sort of respect for saving lives.”

Mosaic Life Care, which has locations in St. Joseph, Maryville and Albany, has no current plans to stop accepting Medicare Advantage, Mosaic Public Information Officer Joey Austin confirmed.

St. Joseph resident Frank Roberts uses government-based Medicare with an insurance subsidy but said choosing an option could be confusing, especially with how it is promoted.

“I don’t know how well-publicized (this is) because there’s so much advertising out there for so many other plans to actually be a subsidy to Medicare,” he said. “And in this area, there’s a couple brands, companies that they feel that are the best fit for this.”

Many people don’t realize Medicare Advantage is not the same as government-based Medicare, Abrutz said.

One of the key issues for Cameron Regional was the difference in compensation. Hospitals receive less value for services when accepting Medicare Advantage than when a patient has Medicare through the government, Abrutz said.

“I’ll tell you what started, what started as our due diligence,” he said. “When we identified that we are going to pay more for prison care than Medicare Advantage care, that kind of says it all.”