In the spring of 2022, Gary Bent underwent surgery to remove a bleeding lesion in his brain resulting from melanoma. The procedure left him with severe mobility and cognitive impairments — he couldn’t walk or remember how to read a calendar.
Bent’s physicians said he needed intensive rehabilitation. Luckily, there was a spot available at one of only three facilities in the state that provide that level of care. Then, Bent’s Medicare Advantage plan denied the prior authorization.
“It boggles my mind that the physician and the physical therapist who are at his side every day say that he needs this care, and someone, somewhere in the Medicare Advantage plan who’s never even seen or met my husband says, ‘No,’” said Bent’s wife, Gloria, during a press conference at the state Capitol on Wednesday organized by lawmakers to call attention to problems with Medicare Advantage.
Medicare Advantage is a type of Medicare plan offered by a private company, and it’s come to dominate the market. Both nationally and in Connecticut, over half of Medicare beneficiaries are enrolled in Medicare Advantage as opposed to traditional Medicare.
These plans often have lower premiums, but are much more likely to have prior authorization requirements and limited provider networks, which can leave people stranded when they need care most. They are also more expensive on a per enrollee basis than traditional Medicare, which critics say is a waste of taxpayer dollars.
U.S. Sen. Richard Blumenthal, D-Conn., said consumers should be aware of the pitfalls of Medicare Advantage plans going into Medicare open enrollment, which begins on October 15.
“Don’t just jump into Medicare Advantage because the insurance company tells you it’s better for you. In fact, it may be hazardous to your health,” Blumenthal said.
But many consumers don’t have a choice. Increasingly, many employers, including the state of Connecticut, only offer retirees coverage through Medicare Advantage. Gary Bent worked as a physicist at the University of Connecticut for more than two decades, which is how he ended up in a Medicare Advantage plan.
Instead of the intense rehabilitation that his doctors recommended, Bent’s insurer approved care at a short-term rehabilitation facility, but continued attempts to terminate payment for services over the course of his 49-day stay. After three tries, the insurance company succeeded in denying care, and Brent was discharged. Within hours, he returned to the hospital with bacterial meningitis and remained in critical care for three weeks.
“We are one family in an ocean of families who have been struggling under a barrage of denials,” said Gloria, who, along with her daughters, became her husband’s primary caretaker until he died in March 2023.
Judy Stein, the executive director at the Center for Medicare Advocacy, said she continues to hear from patients who, like Bent, have been denied critical care. She recently spoke with a 94-year-old former Connecticut state employee who, after suffering a bad fall, was denied coverage by her Medicare Advantage plan for her stay at a skilled nursing facility.
“This is not just inhumane, it’s expensive,” said Stein. “We need to pay for what people need and stop paying insurance companies an astounding rate to deny what people need when they’re sick and injured.”
Both Blumenthal and Sen. Saud Anwar, D-South Windsor, called Wednesday for immediate reform.
“I stand united with everyone here to make sure that we get the word out that this is not a sustainable model,” said Anwar.
A lobbyist with the Connecticut Association of Health Plans declined to comment.