Prior authorizations are the way MA managed care plans pre-approve some procedures before they’ll pay for them.

Will your care be denied? Medicare Advantage insurers use prior authorization to manage utilization and lower costs. How does your plan measure up?

Shifting from reducing MA capitation by an across-the-board coding intensity adjustment factor to Medicare Advantage organization (MAO)-specific adjustment factors would improve the financial outlook for many MAOs but reduce or eliminate the financial gain for MAOs that upcode aggressively.

Once a person buys a Medigap policy, it is guaranteed renewable. With few exceptions, the insurer must renew the policy each year, if the beneficiary chooses, without any medical underwriting. Premiums must be the same as for others in the beneficiary’s class.

Medicare Advantage enrollees can switch plans or transfer to original Medicare during the open enrollment period ending March 31.

How does your Medicare Advantage plan stack up when it comes to coverage denials? You may be surprised. The overall denial rate was 6.4% in 2023, the latest year data was available, according to an analysis by the nonprofit Kaiser Family Foundation.