By Katy Golvala
CT Mirror, October 2, 2024
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.
