AHIP’s Post

People in Medicare Advantage Plans More Likely to Report Delays in Their Care, Survey Finds 🕐 🕜 🕣 Enrollment in private Medicare Advantage (MA) plans, now almost equal to that in traditional Medicare, continues to rise. This growth raises questions about how the coverage experiences of people in MA plans compare to those in traditional #Medicare. According to a new survey from The Commonwealth Fund Fund, two-thirds of beneficiaries — regardless of which form of Medicare they have — say their coverage fully meets their expectations. But while similar shares of beneficiaries in both groups said they had to wait over a month to see a doctor, those in MA plans were more likely to report delays in their care due to needed approval. Seven of 10 #MedicareAdvantage enrollees, meanwhile, said that in the past year they used some of their plan’s supplemental benefits, such as vision and dental — neither of which are covered by traditional Medicare. Read our new brief to get complete survey results.

💡 #DYK: Over half of the eligible #Medicare population is enrolled in a Medicare Advantage (MA) plan. This is a private plan alternative currently used by nearly 31 million beneficiaries in 2023, but what changes are coming for 2024?   While there will be a slight decrease in plan options for 2024, however, the number of MA plans has more than doubled since 2018, giving the average beneficiary 43 plans to choose from in their area and 3,959 options offered nationwide. Additionally, most plans will continue to offer additional benefits beyond standard medical coverage including vision, dental, and hearing benefits.   Medicare enrollment ends next month, so I am interested in seeing how these factors, among others, will affect MA enrollment numbers for the upcoming 2024 benefit year. https://lnkd.in/gXwYyv9V

Proud to have spearheaded Families USA comments on the CY2025 Medicare Advantage (MA) Rate Notice. We applaud the Centers for Medicare & Medicaid Services for the steps they have taken thus far to rein in the corporate abuses in MA, however they must do more. As MA now covers more than half of Medicare patients, it is critical we hold MA plans accountable to delivering high quality, affordable, & equitable care. Yet allowing these private plans to upcode & drive hundreds of billions in overpayments undermines the very incentives in the MA payment system that are designed to ensure plans are providing the coverage our nations seniors and their families and all those who rely on Medicare deserve. Ultimately we urge the Centers for Medicare & Medicaid Services to do the following as they finalize their rate notice for CY2025: 1) up the coding intensity adjustment above the min 5.9%, 2) exclude diagnoses from informing risk adjusted payments when based solely on health risk assessments and chart reviews, 3) use 2 years of FFS and MA data to inform payments, & 4) make fundamental changes to the risk adjustment model used to inform MA payments to strengthen payment accuracy and to drive equitable care delivery (such as adding variables based on data that can’t be easily gamed)

🟢 Medicare Advantage Open Enrollment Runs to March 31 🟢 ✅ If you’re already on a Medicare Advantage plan, you can take advantage of the open enrollment period to switch to another Medicare Advantage plan or drop your Medicare Advantage plan and switch to original Medicare and perhaps also a separate Medicare drug plan. ✅ Cost is the #1 reason enrollees choose to switch their plans. ✅ If you’re currently on a Medicare Advantage plan and are considering whether to switch during open enrollment, speak to a Medicare Benefits advisor who can walk you through all the options available in your area. https://lnkd.in/efM75pTZ

According to a report by the Kaiser Family Foundation, 54% of Medicare-eligible individuals will be enrolled in Medicare Advantage (MA) plans in 2024. This reflects a significant increase in MA enrollment, which continues to grow as more beneficiaries opt for these plans over traditional Medicare. Factors like additional benefits and out-of-pocket cost limits drive the ongoing popularity of MA.

https://lnkd.in/eAhHD4as Important to continue to share the truth about Medicare Advantage and why over 50% of Medicare beneficiaries have selected it.

The most comprehensive prior authorization findings I've seen courtesy of KFF using 2019 - 2022 Medicare Advantage (MA) data. ↠The number of auths requested is up in 2022 to 46 million, but largely due to the growth in MA enrollees since the # of auths per enrollee was at 1.7 in both 2019 and 2022. ↠The share of denied prior auth requests was steady from 2019 - 2021 (around 5.7%) and jumped to 7.4% in 2022. ↠Only 1 in 10 denials were appealed in 2022 yet 83% of appeals overturned the initial decision. CVS issued the highest # of denials at 13% and Anthem the lowest at 4.2%. Humana had the highest # of prior auth requests per enrollee at 2.9. ↠Services subject to prior auth varied across MA plans. Based solely on my caregiving experience, there was no shortage of fingerpointing on auth status between plans and their contractors and providers. The KFF piece also recognizes the three recent prior auth final rules and legislation introduced. Alas, the work continues as it should. #priorauth #MA

#ParagonPIC: Medicare Advantage is now the most popular form of coverage in #Medicare (51% of enrollees). MA has demonstrated better health outcomes, lower costs for basic Medicare benefits, and higher value for seniors. #MedicareAdvantage enrollment soared after the ACA, significantly outpacing Congressional Budget Office's past predictions. CBO’s 2013 projection forecasted that 30% of Medicare enrollees would be in MA in 2023—well below the 51% of enrollees choosing MA last year. As Medicare Advantage grows, patient choice is transforming the Medicare program. Policymakers can improve MA even more by increasing its cost efficiency and flexibility to provide innovative and high-quality coverage. #MedicareAdvantage #Medicare #ParagonPIC READ MORE: https://lnkd.in/ej8hgjeP

Growth of Medicare Advantage: What Providers Need to Know

Transparency helps everyone! If you, your retirees, your employees need help navigating Medicare, contact me at [email protected] #Medicare #MedicareAdvantage #MedicareOptions #MedicareABCD #Retirementplanning #EmployeeBenefits #healthcare