CLARION — Iowa Specialty Hospitals and Clinics will no longer accept certain Medicare Advantage plans. This is a move hospital leaders say is meant to protect patients and staff from a system that often delays or denies needed care.

Medicare is the federal health insurance program for people 65 and older. Medicare Advantage plans are run by private insurance companies. Funded with federal dollars, they must cover the same basic services as Medicare, but hospital leaders say they frequently add hurdles such as prior authorizations, narrow provider networks, and slow reimbursements.

The difference often becomes clear inside the hospital.

“When we have patients on Medicare Advantage plans, many of the plans require pre-authorization for services,” said Chief Nursing Officer Beth Carder.

She noted multiple cases where doctors and nurses recommended continued care, but insurers determined there was not medical necessity for the services.

“Families are confused and frustrated because their patient isn’t authorized for those services,” Carder said. “Some have ended up paying privately, which can get pricey as well.”

Chief Compliance Officer Reagan Swisher said many patients don’t realize how different Medicare Advantage is from traditional Medicare. “Many families think that when they have Medicare Advantage … it’s Medicare, because of that Medicare Advantage name,” he said. “Health insurance is difficult to understand on a good day.”

Iowa Specialty Chief Executive Officer Steve Simonin said the hospital is preparing to notify patients about which plans will no longer be accepted. Some Advantage plans will still be accepted.

“We are planning on sending a letter via MyChart to all of our patients discussing which Medicare Advantage plans we don’t accept,” he said.

Hospitals nationwide are making similar moves. At least 27 health systems have stopped accepting certain Medicare Advantage plans, citing excessive prior authorization denials and slow insurer payments. On average, the federal government pays insurers about $1,000 a month for each enrollee, but hospitals say that hasn’t always translated into reliable coverage for patients.

To help patients sort through their options, leaders point to SHIIP, the Senior Health Insurance Information Program, a free, confidential service run by the Iowa Insurance Division.

SHIIP volunteers in Wright County are available in Belmond, Clarion, Hampton, and Garner to help seniors compare plans before they enroll. They also are available in Webster County.

Medicare’s open enrollment period runs from September through December. Iowa Specialty leaders say they hope residents take time to review their choices carefully. “This isn’t about making life harder on patients,” Simonin said.

Ultimately, the hospital system wants patients to understand the coverage they are signing up for. “They’re our neighbors,” Simonin stated. “In Iowa, we take care of our neighbors.”

Amanda Rink is editor of The Wright County Monitor. This story is published through a cooperative effort between The Monitor and The Messenger.