Medicare Program Suddenly Ending Leaves Seniors in Limbo

Some hospice patients on Medicare Advantage are now facing uncertainty after the government ended a pilot program.

Medicare Advantage is one of the top programs for seniors looking for health insurance, and more than 50 percent of those eligible now use the privatized Medicare Advantage option instead of just traditional Medicare.

In 2021, Medicare announced a pilot program to offer hospice coverage through Medicare Advantage. However, in March, Medicare announced they were ending the pilot program for end-of-life services, five years before it was previously scheduled to end in 2030.

Reasons cited for the change included a reportedly low amount of interest in the program and operational issues.

"Ending the pilot program will reintroduce challenges around fragmented care, limited provider choice, potential cost liabilities, and lack of quality oversight," Michael Ryan, a finance expert and the founder of michaelryanmoney.com, told Newsweek.

Those who are on Medicare Advantage will still have hospice coverage under traditional Medicare but the pilot program hoped to streamline the process through Medicare Advantage.

According to the Medicare Payment Advisory Commission, around half of 1.7 million Medicare Advantage recipients who died in 2022 were in hospice for end of life care.

When Medicare Advantage started offering coverage options for hospice, Ryan said the reaction from hospice and patients was largely negative. He said there were many issues, namely limited care coordination and financial liability for nonhospice services. Patients also found themselves with limited options for their choice of hospice care and very little oversight or quality monitoring.

"The decision to end the Medicare pilot program has major implications for hospices and patients. While resolving some hospice payment issues, it reintroduced challenges," Ryan said. "In essence, ending the hospice carve-in pilot means MA enrollees electing hospice will revert to the traditional Medicare hospice benefit model."

Newsweek reached out to the Centers for Medicare and Medicaid Services for comment via email.

As beneficiaries and health care providers look ahead to the future, many are still hoping Medicare Advantage will find a way to integrate its coverage options with hospice, which continues to be a sorely needed medical service.

"This is by no means the end of the story for end-of-life care providers and MA plans," Ethan McChesney, policy director at the National Partnership for Healthcare and Hospice Innovation, told Axios.

While hospice is one area where Medicare Advantage has been lacking, seniors have had plenty of other complaints about the privatized version of Medicare.

The coverage option often lowers out-of-pocket costs but can be limiting in what providers and treatment options are available to patients. Due to this complication, many older, sicker and lower-income rural Americans stick to traditional Medicare because the Medicare Advantage options available in their area are minimal.

There's also been sufficient cuts made to the Medicare Advantage plans by major insurers. Humana already announced it would be cutting its Medicare Advantage plans by 2025, and about 6 million Americans could be affected.

Many more insurers are likely to follow suit.

"We acknowledge that the industry is experiencing a dynamic and challenging time that we must navigate," CEO Bruce Broussard told investment analysts during a quarterly call last Wednesday.