Radar on Medicare Advantage

Medicare beneficiaries in nearly every state will have more Medicare Advantage plans to choose from and see lower premiums this fall when shopping for coverage, according to CMS’s recently released landscape files for the 2023 plan year. And both major insurers and regional plans at press time were touting new offerings such as Part B buyback plans, flexible spending features that include allowances for utilities, and enhanced dental coverage. 

“What we’re seeing is kind of a continuation of what we’ve seen in the past several years, which is expanding of not only the big five but also of the smaller insurers as well, and then increased focus on supplemental benefits and the Special Supplemental Benefits for the Chronically Ill (SSBCI), and continued expansion into the D-SNP [Dual-Eligible Special Needs Plan] market,” observes Betsy Seals, co-founder and CEO of Rebellis Group, LLC.

Many of the medical loss ratio (MLR) reports that Medicaid managed care organizations are submitting submit to states are incomplete, and much of that missing data concerns how much MCOs are spending on administrative services, according to a new report from the HHS Office of Inspector General (OIG). 

The report, published in September, is part of a “body of work” that the watchdog agency initiated a few years ago that focuses on the implementation of the federal MLR requirements for Medicaid managed care ushered in via the 2016 update to MCO regulations, the HHS-OIG Office of Evaluation and Inspections tells AIS Health via email. The new report builds upon a data brief issued in August 2021 that “served as a first-of-its-kind nationwide landscape of Medicaid managed care MLRs,” and found that most states established a minimum MLR of 85% for their contracted MCOs. That means plans must spend at least 85% of their premium revenue on covered health care services and quality improvement activities.

There is limited evidence to suggest any major differences exist between Medicare Advantage and traditional, fee-for-service (FFS) Medicare when measuring beneficiary satisfaction, according to the Kaiser Family Foundation’s (KFF) recent literature review of 62 studies comparing the two programs. Nor did either program consistently stand out across quality measures. There were also few differences in length of hospital stays for common ailments or aggregate days spent in inpatient care between the two groups.

There were some measurable differences between the two programs, however. In general, MA members were more likely to access preventive care, such as wellness visits and annual flu shots, and more often reported having a usual source of care. They also fared better on some utilization measures, reporting lower rates of home health, inpatient rehabilitation and skilled nursing facility use. MA enrollees without certain chronic conditions, such as cancer or diabetes, also reported better experiences accessing their prescription drugs. Traditional Medicare enrollees, meanwhile, were more likely to be treated in facilities with high quality ratings. Notably, traditional Medicare enrollees with supplemental coverage reported fewer cost-related difficulties than MA members.