How Beneficiaries Really Feel About Medicare Advantage vs Traditional Medicare

MA plans offer “extra benefits” but many go unused. Is Medicare Advantage really better?

https://www.medpagetoday.com/special-reports/features/108846

Survey results released today contradict widely-held beliefs that Medicare Advantage enrollees are more satisfied because they receive better health services than those in traditional Medicare.

On the contrary, respondents in the two types of Medicare plans reported equal satisfaction, although more Medicare Advantage (MA) enrollees than traditional Medicare (TM) beneficiaries said their care was delayed because of the need for prior approval. This trend sheds light on potential considerations for those exploring Medicare Advantage plans 2024.

The reportopens in a new tab or window by The Commonwealth Fund analyzed responses from 3,280 Medicare beneficiaries between November 6, 2023, and January 4 in an effort to learn “What Do Medicare Beneficiaries Value About their Coverage?” Those surveyed gave their opinions on the ease of their access to benefits, care coordination, services, and satisfaction.

“Overall, the experiences seem to be similar for those in traditional Medicare versus Medicare Advantage, with some notable exceptions,” Gretchen Jacobson, PhD, vice president of Commonwealth’s Medicare program, told MedPage Today.

The comparison of beneficiary experiences in each model is important because roughly half, or 52% of 66 million eligible people, are now enrolled in MA plans, to which federal funds pay billions more than for TM care. In 2024, for example, MA plans are expected to receive $88 billionopens in a new tab or window more than what would have been spent if the same people were in TM.

Although there are efforts underway to contain that spending through new payment policiesopens in a new tab or window, MA enrollment is projected to continue rapid growth. So it’s important that taxpayers understand what they’re getting for all that extra money.

A perhaps surprising finding of the survey was MA enrollees’ relatively low use of their “extra benefits,” such as vision, hearing, and dental care, considering that plans aggressively market these benefits to encourage signups. Jacobson noted that Medicare pays the plans $1,915 a year per enrollee for these benefits, according to the 2023 annual reportopens in a new tab or window from the Medicare trust funds’ trustees. These extras are not covered under TM.

For example, 31% of MA enrollees hadn’t used any of their benefits in the last 12 months, 58% hadn’t used dental benefits, 59% hadn’t used vision benefits, 93% hadn’t used hearing benefits, 81% hadn’t used the gym membership, and 54% hadn’t used their over-the-counter medication allowance. Other benefits such as meal delivery and an allowance for groceries may be less frequently offered by the plans, but 98% and 88%, respectively, said they hadn’t used them.

“Because this is an important component of what Medicare Advantage plans are offering, we need to understand better why they aren’t using them, and whether these are the benefits people really want,” she said.

For those who hadn’t used any benefits, 63% of respondents said they didn’t need them, 24% said they didn’t know what benefits the plans offered, 9% said the benefits were hard to use, and 4% said the costs were too high.

Some underlying reasons for the low rates of use, not specified in the report, could be because of restrictions. Perhaps the networks or setting one would have to use — for example, a group of dentists — excludes one who has long served the family. But it also might be because enrollees don’t know about them or forgot about them, despite the ubiquitous advertisingopens in a new tab or window that prominently pitches them.

A CMS proposed ruleopens in a new tab or window would, if finalized, require MA plans to send mid-year notices to enrollees about any unused benefits, to “ensure MA plans are better stewards of the rebate dollars directed towards these benefits,” the proposed rule says.

A big selling point for MA plans is that their providers cooperate within carefully picked integrated networks and coordinate care far better than providers who treat TM beneficiaries.

But here, the survey responses revealed another contradiction. Regardless of whether they had an MA or a TM plan, about an equal number of respondents said they coordinate their healthcare services themselves: 75% in MA and 73% in TM.

Some 7% of people on MA said their plan helps to coordinate their care, Jacobson said. “It seems as though the plans are certainly not the primary care coordinator for most Medicare Advantage enrollees.”

Jacobson acknowledged that MA plan providers might be coordinating their patients’ care in ways enrollees aren’t aware. “But from the beneficiaries’ perspective, they don’t see their plan having a large role in coordinating care.”

Another counterintuitive finding is that a similar percentage of MA and TM respondents said they waited more than one month to see a doctor (36% and 34%), perhaps suggesting that MA enrollees do not get faster access for appointments. “Access to providers seems to be similar, which is counter to some thoughts around the limitations around provider networks,” Jacobson said.

Of the MA plan respondents, 22% said their care was delayed because it required approval, compared with 13% of TM beneficiaries. Far fewer services under TM require pre-approval compared with MA, so it was unclear why so many TM beneficiaries encountered obstacles.

Another surprise was that a larger share of people in MA said they had problems affording care compared with people in TM, “which is contrary to how we typically think of Medicare Advantage,” Jacobson said. “It doesn’t appear that Medicare Advantage plans are necessarily making care more affordable for people.”

Similar percentages of the two beneficiary groups also said their benefits do not cover what they needed, that they were unsure of what benefits they had, that costs were too high, and that they need transportation to access benefits.

Jacobson noted that if Medicare pays more per capita to MA plans than for TM care, it results in higher Part B premiums to all beneficiaries, regardless of what type of plan they’re in. Most frequently, the premium is paid through an amount withheld from their social security retirement benefit checks.

Another finding of note evaluated health risk assessments both types of Medicare patients received in the last year. Of those who received them, few said it caused their doctor to change their care or led to more services or benefits. Only 6% of both MA and TM beneficiaries said their doctor changed their care plan as a result.

“This really calls into question the value that these assessments are providing to beneficiaries and what frequency it’s important to have them,” Jacobson said.

Asked if the survey responses may raise questions about whether MA plans are worth their extra cost, Jacobson replied: “What our survey shows is that the experiences people report seem to be similar overall for those in Medicare Advantage versus traditional Medicare.”

That, she said, makes it “worth assessing the relative value of care and benefits people in Medicare Advantage and traditional Medicare are receiving relative to the amount spent by the federal government. This is worth keeping an eye on as enrollment in Medicare Advantage grows.”

Because it’s well known that Medicare recipients are frequently confused over what kind of coverage they have, the plan type was verified through Zoom calls in which respondents showed their plan card.

 

Filed under: General Problems