Radar on Medicare Advantage

As marketing experts from regional Medicare Advantage plans and their strategic partners shared success stories from the recent Medicare Annual Election Period and their year-round member engagement campaigns at the 14th Annual Medicare Market Innovations Forum, there was one commonly recurring theme: Today’s MA beneficiaries are increasingly embracing technology for everything from conducting AEP research to maintaining a healthy lifestyle. 

In his experience working with digital marketing agency Amsive, Dan Paladino noted that Medicare consumers are relying on digital tools to research their coverage options “early and often” and that clients have experienced a surge in digital use “across many channels” this past AEP.

Family caregivers have long been regarded as an important part of care teams for high-needs Medicare beneficiaries, especially those enrolled in Dual Eligible Special Needs Plans (D-SNPs). But there are strong cases for Medicare Advantage insurers to support caregivers as part of their broader care management strategy, as they can help improve outcomes, reduce costs and enhance member experience, according to speakers at a session of the AHIP 2023 Medicare, Medicaid, Duals & Commercial Markets Forum, held March 14-16 in Washington, D.C.

Although there is “concurrent public policy and private solution[s] and investment going on in the caregiver space,” multiple challenges exist with activating them, from identifying potential caregivers to supporting them with the training they need to identify issues such as a change in condition, observed John Mach, M.D., founder and general manager of Mach Health Care Strategies, LLC, during the panel discussion, “Achieving the Triple Aim for Medicare Members by Activating Family Caregivers.”

If the federal government decreased payments to Medicare Advantage plans — something of a boogeyman for insurers in recent years — would seniors see higher premiums and a reduction in the availability of supplemental benefits? That’s a question a new study published in the April 2023 issue of Health Affairs aimed to answer, to mixed results. 

Using a nationally representative sample of both MA and traditional Medicare data from 2012 to 2019, researchers sought to estimate the impact of changes in MA benchmark payments on plan premiums, member cost sharing and supplemental benefit availability. (One of the study’s four co-authors is Harvard University’s Michael Chernew, Ph.D., chair of the Medicare Payment Advisory Commission, which has long argued that MA plans are overpaid relative to traditional Medicare.) The benchmark is an annual payment established by CMS to determine the maximum amount that Medicare will pay an MA plan for providing services to each member. The amount is calculated based on traditional Medicare costs in a given service area and is adjusted based on member health status and the plan’s individual offerings. If an MA plan's bid is below the benchmark in its county, the difference is returned to the plan and can be used to provide supplemental benefits and/or lower premiums. If the bid is above the benchmark, the plan must cover the additional cost or pass it on to members in the form of higher premiums or cost sharing. 

In a final rule making policy and technical changes for contract year 2024, CMS on April 5 finalized multiple provisions aimed at ensuring continuity of care for Medicare Advantage members, improving health equity and easing behavioral health access. And while the rule finalized most of the Biden administration’s proposals around misleading marketing practices in MA, industry experts say CMS walked back and modified a few proposals as it waits to see how some of the new requirements play out in practice.

In a fact sheet on the final MA and Part D rule, CMS said it finalized 21 out of 22 marketing provisions that appeared in the proposed rule. But CMS left out one notable provision that would have potentially disrupted a plan’s ability to purchase leads from third parties and indicated it will consider it in future rulemaking.