A decision by Southwest Medical Associates to stop covering traditional Medicare patients — those who don’t have private add-on coverage to supplement their federal insurance — means nearly 7,000 seniors in Southern Nevada will have to find new doctors by Jan. 1.
Southwest currently serves 45,000 Medicare Advantage patients and 6,900 standard Medicare patients.
It has been one of only two major providers for Southern Nevada seniors with Medicare — the federal insurance program for those 65 and older — without supplemental coverage provided by private companies, such as a Medicare Advantage plan. With its withdrawal from the market, HealthCare Partners Nevada will be the only remaining large provider.
The change, which was not publicly announced, will impact seniors who don’t qualify for Medicaid, a federal program that provides coverage for low-income adults and others, but haven’t purchased the generally more-expensive add-on coverage.
‘Advantage plans are better’
Southwest, which manages a network of health care providers, released a statement late Friday afternoon saying that it was making the change to provide better care for its customers.
“Southwest Medical is making this change because Medicare Advantage plans are better for our patients, with better coordinated care and better health outcomes,” it said. “We’re working closely with our patients to help them through this transition.”
A study published in January by the National Bureau of Economic Research found that Medicare Advantage plans do offer higher quality than traditional Medicare, but also are more profitable for insurers.
James Stover, a public relations specialist working with Southwest, said officials with the company declined to respond to emailed questions from the Review-Journal about whether the decision would mean more profits for the company in the future.
Many primary care doctors in Las Vegas decline to take Medicare because they say reimbursement is less than private insurers and paperwork is more onerous.
Older low-income population grows
The company’s withdrawal from the traditional Medicare market comes as older residents continue to fuel Clark County’s population growth. The area’s over-65 population grew by nearly 6 percent in 2013, as 14,204 new retirement age residents outpaced the entire number of new working age residents and nudged the county’s median age from 36.1 to 36.4 years.
Meredith Levine, director of economic policy at Nevada’s Guinn Center for Policy Priorities, recently noted that the state has “the fastest growing low-income senior population in the country.”
Stover said the two Medicare Advantage Plans that Southwest will continue to accept are issued through Senior Dimensions Southern Nevada and AARP, both of which are managed by United Healthcare. Southwest is part of OptumCare, which is owned by United Health Group.
Medicare Advantage is hospital and medical insurance for seniors and others who qualify for Medicare that is provided by private companies rather than the federal government.
Also called “Part C” plans, they provide the same Part A (hospital) and Part B (medical ) coverage that Medicare does, with the exception of hospice care.
Medicare Advantage Plans usually provide Part D (drug) coverage and most plans also offer extra coverage options, like vision, hearing, dental and health and wellness programs. People usually pay an additional monthly premium for a Medicare Advantage Plan.
Founded in 1972, Southwest Medical has more than 350 local providers in over 30 health-care centers.
Services includes six urgent care centers, two outpatient surgery centers, two lifestyle centers catering to older adults, home health services, the NowClinic telemedicine platform and Southwest Medical Associates Hospice.