Why an Oregon health system wants its patients to avoid Medicare Advantage

Bend, Ore.-based St. Charles Health System is considering dropping all Medicare Advantage plans and is encouraging its senior patients not to enroll in the private Medicare plans during the next open enrollment period. 

St. Charles is currently contracted with MA plans offered by Humana, PacificSource, and Centene's Health Net and WellCare, according to an Aug. 14 news release.

The health system's president and CEO, CFO, and chief clinical officer encouraged patients not to enroll in MA plans this fall, citing higher rates of claims denials, longer hospital stays and overall administrative burden for clinicians. The health system noted that most MA carriers have faced allegations of billing fraud from the federal government and are being investigated for high denial rates.

"We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist," CFO Matt Swafford said.

St. Charles said it will continue to evaluate its MA contracts through the fall and winter.

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