A Missouri woman, 70, couldn’t afford her $8K/month drug after Medicare Advantage denied coverage — and landed in the ER Older Americans opt into Medicare Advantage plans thinking it’s cheaper health insurance, then face unexpected costs — some life-threatening.
Unlike traditional Medicare, Medicare Advantage requires patients to get an insurer’s prior authorization for medications and services before receiving insurance coverage
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Insurers can — and frequently do — deny prior authorization, leaving patients financially on the hook or without prescribed treatment. Unfortunately, the latter can seriously impact a patient’s health. As the Washington Post reports (1), that’s what happened to 70-year-old Medicare Advantage enrollee Margaret Hvatum, who ended up hospitalized in late January.