Those that push MAPD should read this view from a person who worked on the provider side.
So having worked both as an insurance agent now and having left healthcare practice administration I can offer this.
I was part of the administration of a de novo startup practice that focused on outpatient orthopedics. I reviewed and signed our physician contracts at practice inception. When it comes to physician contracts from carrier to carrier, the contract rates are generally total trash for the physicians. We are talking 60-70% of Medicare Fee schedule. In general, the larger the network is, the lower the physician contracted rate will be. As the carriers grow, and thereby control more market share, they push their contract rates even lower because - guess what - when you control 30-40% of the local market share, physicians are forced to accept the contracts because they can't sustain a viable practice if they say that they are willing to block out 30 to 40% of their available patient markets.
Then imagine you are the physician. The original Medicare fee schedule for a new patient exam level 5 99205 (CPT) is $172.51. But you have a Humana contract that only pays you 60% of the 2021 fee schedule. So instead of getting $172.51, you now get $103.50You took a 40% hair cut while performing the same high quality level of care as you do for any other patient. Then add on top of it that, in order to even be reimbursed for the service, you are going to need to expands on your clinical documentation so that you can submit for pre-authorization. Effectively, being asked to do more work for less pay. Add to that that insurance companies routinely deny claims that should be paid
Medicare Advantage plans skimp on claims, care, federal report finds
Imagine your IMO going to you and saying "you know what, we have so many agents in your market that your services are diluted in value, so we are cutting your renewals by 40%". Meanwhile you are doing the same work and getting nearly half the pay.
To those that say they do countless Medicare Advantage enrollments and hear no complaints - you personally wouldn't. We (as in those that work in healthcare or have worked in healthcare) deal with them in clinic on your behalf. People showing up in clinic that are D-SNP having 6 different insurance cards (because they get churned every quarter) and have no idea which is their primary, in tears because they don't stop getting calls from insurance agents. Having to tell patients that are writhing in pain in your waiting areas that they can't be seen because they don't have a referral and their agent didn't tell them they would need one. Seeing patients come to clinic that are part of small capitated networks that were told by their primaries that "its just arthritis" when they have grade 4 osteoarthritis with avascular necrosis and basically need immediate surgery (this happens because primary care doctors are incentivized in capitated systems to keep costs down and thus generally patients receive lower quality of care - and Medicare will deem the capitated network plans Five Star solely BECAUSE of their ability to keep costs down). Think about your mom being put into a system like that where a physician stiff arms her from seeking additional treatment because it would go cut into his practices bottom line. Mom continues to be miserable with her pain because a white coat physician that she is supposed to trust is telling her that everything is just fine. You would think this sounds crazy but it frankly is exactly the way the system is setup.
MAPD isn't a bad product - it is just generally marketed in an incredibly dubious way. Keep in mind that if you are one of the agents out there force feeding MAPD like there are no negatives with the product and that its a "no-brainer" to enroll, you are really contributing to your own lack of freedom, choice, and accessibility when it comes time to retire and need your own plan, which by that point will probably all be MAPD and you just get what is given to you.
