The Kaiser Family Foundation just released a new study looking at more than 60 past studies of Medicare Advantage. The takeaway is familiar: People with few health care needs fare well in Medicare Advantage. People with costly and complex health care needs receive less post-acute care: they get less nursing, rehab and home health care, often from lower quality providers, in Medicare Advantage. When deciding whether to enroll in Medicare Advantage, keep in mind that health insurance should meet your unforeseeable health care needs down the road.
The 62 studies, conducted since 2016, focused on people’s experiences affording health care, using health care and getting quality care in traditional Medicare and Medicare Advantage. The authors found that people in Medicare Advantage were less likely than traditional Medicare enrollees not only to use post-acute services but to get treatment in hospitals, skilled nursing facilities, and home health agencies which have the highest quality ratings. The study could not determine whether less use of post-acute care jeopardized health outcomes of study participants.
We already know from the HHS Office of the Inspector General that Medicare Advantage plans use prior authorization requirements for post-acute services that inappropriately delay and deny care their enrollees need. These “widespread” inappropriate delays and denials likely contribute to why MA enrollees use fewer of these services than people in traditional Medicare, which has no prior authorization requirements for these services. It’s also likely why people with costly conditions tend to disenroll from Medicare Advantage plans at higher rates than other people.
The data also show that people in Medicare Advantage often forgo care in order to avoid going into medical debt and/or having no money to pay for food and rent. Copays and deductibles can be high in Medicare Advantage plans, particularly for post-acute care. People in traditional Medicare, particularly those with supplemental coverage, experience fewer cost-related problems.
Medicare Advantage plans do not appear to do a better job of keeping enrollees healthy than traditional Medicare, based on the available data. Satisfaction rates with both care and wait times is similar in traditional Medicare and Medicare Advantage.
Here’s more from Just Care:
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Well-kept secrets of Medicare Advantage plans
- If you’re making a Medicare choice, don’t trust the insurance agent
- Ten ways to improve Medicare Advantage