Fierce Healthcare January 7, 2022
Traditional Medicare coverage rules make up the bulk of denied services and spending compared to a Medicare Advantage plan, according to a new study in the latest Health Affairs issue.
The study, led by the University of Pennsylvania, Harvard University and CVS Health, relied on Medicare Advantage claims that were denied for beneficiaries enrolled with Aetna from 2014 through 2019. In total, the authors identified $416 million worth of denied spending, or $60 of denied spending per beneficiary annually. Traditional Medicare coverage rules made up 85% of denied services and 64% of denied spending, while Aetna’s MA plans made up the rest.
In total, the sample included nearly 3 million beneficiaries. The study did not include services that...
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