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Topic: Medicare advantage

Medicare Advantage is a private health insurance alternative to traditional Medicare, offering seniors additional benefits but raising concerns about algorithm-driven coverage decisions.

More on: Medicare advantage

The podcast episodes provide in-depth coverage of the Medicare Advantage program, highlighting key issues and trends within this insurance market.

Several episodes discuss the use of algorithms by insurance companies to make coverage decisions for seniors enrolled in Medicare Advantage plans, with concerns raised about transparency, bias, and the inability to appeal algorithm-driven decisions. For example, Episode 13405 investigates how algorithms are used to deny care based on projected lengths of stay rather than patients' actual conditions.

Other episodes explore the financial challenges faced by insurers in the Medicare Advantage space, including rising costs and profitability concerns. Episode 11406 summarizes growing dissatisfaction among health systems with the Medicare Advantage program, while Episode 5764 features a former CMS administrator strongly criticizing the program for overpayments and profits for insurance companies. The impact of these trends on the stock performance of major healthcare payers is also examined in Episode 2851.

Several episodes also highlight the strategic importance of the Medicare Advantage market for healthcare organizations, with Episode 81 discussing Stanford Health Plan's focus on this line of business and Episode 23655 covering Devoted Health's mission to improve healthcare for seniors through a Medicare Advantage-focused model.

All Episodes