The New York Times offered a look at the growth of Medicare Advantage (MA) in an article published on Friday, February 21st entitled “Medicare’s Private Option Is Gaining Popularity, and Critics.”
The title is certainly true. Medicare Advantage’s enrollment has soared to a new record of 24.3 million beneficiaries, driven by seniors who actively choose Medicare Advantage for its lower costs, added benefits, care coordination, and improved health outcomes. As enrollment grows and Medicare Advantage shows that a public-private partnership can modernize Medicare, defense of the status quo has increased as well.
Unfortunately, the Times article took the perspective of those who fear the changes in Medicare as truths. While the article acknowledges the consumer cost savings, high satisfaction, ability to change plans, and extra benefits found in Medicare Advantage, it converted even these key points into negatives. All the while, the article neglects any assessment of the failings in Traditional Medicare – including the need to buy supplemental insurance which, unlike Medicare Advantage, may reject enrollees for pre-existing conditions, the lack of an annual limit on out-of-pocket expenses for consumers, and the fragmented, confusing, and expensive system of care.
In the article, regulatory flexibility that allows Medicare Advantage to offer supplemental benefits that help seniors live longer, healthier lives is cast as “tipping the scales improperly” to Medicare Advantage, rather than an innovation that improves care for beneficiaries without added cost to the government. The article also failed to mention that the new flexibility was not initiated by regulators, but rather was the result of bipartisan legislation passed by Congress in 2018 to improve care for the chronically ill.
The article further characterized the annual Medicare Advantage three-month disenrollment period that allows seniors to revert back to a Traditional Medicare plan as special “flexibility” that favors Medicare Advantage, when the opposite is true. It offers beneficiaries a second chance to opt out of Medicare Advantage. Providing this option in reverse for those in Traditional Medicare would be an easy fix.
The Times’ reporting goes on to state that individuals cannot easily reenter Traditional Medicare because they may be shutout of Medigap (purchased by many in Traditional Medicare to cover out-of-pocket costs, but unnecessary for those in Medicare Advantage). The article suggests this is somehow a flaw in Medicare Advantage. In truth, this is a failing of Medigap policies. Better Medicare Alliance agrees these insurers should have to accept all beneficiaries, regardless of health status, as is done in Medicare Advantage. This would relieve the concern beneficiaries may have that in choosing a Medicare coverage option, they are making an irreversible decision – and may encourage some to try Medicare Advantage.
Below, we offer additional clarification of the issues raised in the article:
Use of Provider Networks in Medicare Advantage
Medicare Advantage plans use a network of providers to keep costs low for patients while ensuring access to the highest quality of care, just like many employer-sponsored plans.
The Times details an unfortunate scenario in which a Medicare Advantage beneficiary received a devastating cancer diagnosis. The beneficiary wished to see a particular specialist for his condition but was unable to do so because the specialist was not in-network with his plan.
Stories such as these deserve to be heard, but some context is important: A Morning Consult poll conducted in late 2019 found that 94% of MA beneficiaries are satisfied with their network of doctors and specialists.
What’s more, changing from Medicare Advantage to Traditional Medicare does not guarantee access to one’s preferred doctor or specialist. The Centers for Medicare & Medicaid Services (CMS) maintains a list of over 25,000 doctors and specialists who have opted out of Traditional Medicare altogether because of its low reimbursement rates.
Since Medicare Advantage is required to offer at least two specialists in every category, there is security in knowing there will be a provider available to meet beneficiaries’ needs and can work in tandem with their primary care team.
Yet, some beneficiaries will want to see a different provider, and in the story relayed in the Times, the beneficiary was able to switch to a different Medicare Advantage plan that allowed him to see his preferred specialist for his care.
Current Administration Showing Favoritism to MA?
The Times’ reporting also suggests that Medicare Advantage has a “leg up” due to recent administrative guidance that grants more flexibility to supplemental benefits in MA plan offerings. It goes further, quoting a Medicare Advantage critic stating that the administration could be breaking the law by raising awareness of the option for MA.
The reality is that, of the 96 documents on Medicare.gov’s free publication library, only four titles allude to Medicare Advantage (this includes one title which refers to MA by the less familiar “Part C”).
Medicare Advantage is still unknown to many Medicare beneficiaries. Polling shows that 45% of seniors were not aware of the option of MA during their first open enrollment period and 32% wish they had known more about their options. Many first-time beneficiaries do not know about Medicare Advantage or find the enrollment process difficult and simply do not make an active choice, which means they default into Traditional Medicare.
At Better Medicare Alliance, we are working to ensure that beneficiaries know their options, understand the difference between Traditional Medicare and Medicare Advantage, and have the decision-making tools to make an active choice. We agree that information presented by the government should “promote an active, informed selection” among Medicare options. Progress has been made in offering clearer, more understandable information on the two ways to receive Medicare benefits, but there is work to do to ensure beneficiaries have full, upfront information on these choices.
While the Times article paints the current administration as an outlier for offering positive statements about Medicare Advantage, administrations and lawmakers on both sides of the aisle have supported Medicare Advantage over the years because they recognize that it consistently delivers superior value for seniors and can transform Medicare for the better.
Medicare Advantage first became law as “Medicare Plus Choice” during the administration of President Bill Clinton. Years later, the Obama administration touted Medicare Advantage’s “better benefits, higher quality care, and lower costs.” Just this month, a record-setting 403 Members of Congress – 75% of Capitol Hill – sent companion letters to the administration expressing strong bipartisan support for Medicare Advantage.
Evidence on Improved Health Outcomes and Lower Costs
“Which type of coverage produces better health outcomes?” asks the Times article. “The evidence is mixed,” it concludes.
Far from it, research shows that Medicare Advantage offers overwhelmingly better outcomes for vulnerable beneficiaries. A 2018 independent report completed by Avalere Health shows that, among beneficiaries with multiple chronic conditions, those enrolled in MA see 23% fewer inpatient hospital stays, 33% fewer emergency room visits, and a 29% lower rate of potentially avoidable hospitalizations.
The Times further claims that the growth of Medicare Advantage has happened without “much public policy debate …. on the costs to government and enrollees.” Not so. Medicare Advantage has been debated and modified over the years, with added accountability and cost containment that sets high expectations. Better Medicare Alliance studied and reported on Medicare Advantage’s impact, with a recent independent report commissioned by our organization finding that Medicare Advantage beneficiaries save an average of $1,276 a year compared to their Traditional Medicare counterparts.
The consumer cost savings in Medicare Advantage rank quite well as compared to the reality faced by too many beneficiaries in Traditional Medicare. A 2019 Health Affairs study found that 53% of seriously ill Traditional Medicare beneficiaries “reported having a serious problem paying a medical bill of any kind” while 23% struggled to pay for basic necessities. More recently, research from the Centers for Disease Control and Prevention confirmed that Traditional Medicare beneficiaries faced more problems with medical bills than those in Medicare Advantage.
As the article points out – and MEDPAC, an independent commission that reports to Congress every year, confirms – payments to Medicare Advantage, including quality bonuses, are now equivalent to payments made for beneficiaries in Traditional Medicare.
Seniors increasingly choose Medicare Advantage for its lower costs, improved outcomes, expanded benefits, and coordinated, quality care. As enrollment grows, there are those who worry that Medicare Advantage’s offerings are too attractive and suggest that its accomplishments hurt Traditional Medicare. This is a false premise that misleads seniors and policymakers.
Medicare Advantage’s success should be recognized as a lesson in what works. To do otherwise disrespects seniors and stymies innovations in health care that can improve quality of life for us all. It is delivering on its guarantee to Medicare beneficiaries, modernizing care delivery and benefits, and addressing many of the failings in Traditional Medicare.
The path to improving health care for every American runs straight through an embrace of the principles that make Medicare Advantage what it is today.