On
September 16, 2022, the Kaiser Family Foundation (KFF) released a report titled
Beneficiary Experience, Affordability, Utilization, and
Quality in Medicare Advantage and Traditional Medicare: A Review of the
Literature. The report reviewed 62 studies published since
2016 that compare Medicare Advantage (MA) and traditional Medicare on a
number of measures, including “beneficiary experience, affordability,
utilization, and quality [and] finds few differences that are supported by
strong evidence or have been replicated across multiple studies” according to a
press release accompanying the report.
As
noted in the report, “[t]he growing role of Medicare Advantage and the
relatively high spending on this program raise the question of how well private
plans serve their enrollees compared to traditional Medicare.” While the press
release noted that “relatively few studies specifically examined specific
subgroups of interest, such as beneficiaries from communities of color, living
in rural areas, or dually eligible for Medicare and Medicaid, making it
difficult to assess the strength of the findings or how broadly they apply”,
the research did identify “noteworthy differences” between MA and traditional
Medicare.
The
Executive Summary of the report states:
We
found few differences between Medicare Advantage and traditional Medicare that
are supported by strong evidence or have been replicated across multiple
studies. Both Medicare Advantage and traditional Medicare beneficiaries
reported similar rates of satisfaction with their care and overall measures of
care coordination. Medicare Advantage outperformed traditional Medicare on some
measures, such as use of preventive services, having a usual source of care,
and lower hospital readmission rates. However, traditional Medicare
outperformed Medicare Advantage on other measures, such as receiving care in the
highest-rated hospitals for cancer care or in the highest-quality skilled
nursing facilities and home health agencies. Additionally, a somewhat smaller
share of traditional Medicare beneficiaries than Medicare Advantage enrollees
experienced a cost-related problem, mainly due to lower rates of cost-related
problems among traditional Medicare beneficiaries with supplemental coverage.
Several studies found lower use of post-acute care among Medicare Advantage
enrollees but were inconclusive as to whether that was associated with better
or worse outcomes. Findings related to the use of other health care services,
including hospital care and prescription drugs, and condition-specific quality
of care measures varied – likely due to differences in data and methodology
across studies.
According
to these studies, MA appears to perform worse than traditional Medicare in
certain areas, including:
- Switching from MA to TM: “rates of switching from Medicare
Advantage to traditional Medicare were relatively higher among beneficiaries
who are dually eligible for Medicare and Medicaid, beneficiaries of color,
beneficiaries in rural areas, and following the onset of a functional
impairment. Switching rates may be a proxy for dissatisfaction with
current coverage arrangements.”
- Post-Acute Care: “lower rates of skilled nursing facility
(SNF), inpatient rehabilitation facility (IRF), and home health use among
Medicare Advantage enrollees, and shorter lengths of stay in SNFs and IRFs
for Medicare Advantage enrollees than traditional Medicare beneficiaries”
- Quality of Providers: “Medicare Advantage enrollees were less
likely than traditional Medicare beneficiaries to receive care in the
highest-or lowest-rated hospitals overall or in the highest-rated
hospitals for cancer care, skilled nursing facilities (SNFs), and home
health agencies.”
- Affordability: “a somewhat larger share of Medicare Advantage
enrollees than traditional Medicare beneficiaries experienced a
cost-related problem, mainly due to lower rates of cost-related problems
among traditional Medicare beneficiaries with supplemental coverage
[…] Medicare Advantage enrollees who are Black, under age 65 with
disabilities, or in fair or poor health were more likely to report
cost-related problems than their traditional Medicare counterparts.”
Correspondingly,
the areas in which MA appears to outperform TM include:
- “use of preventive services”
- “more likely to report having a usual source of care”
- “Medicare Advantage enrollees reported better experiences
getting needed prescription drugs than traditional Medicare beneficiaries
overall, but among beneficiaries with specific conditions, findings were
mixed”
- Hospital readmission rates “were generally lower in Medicare
Advantage than in traditional Medicare”
The
conclusion of the report notes: “As Medicare Advantage plans continue to have
an expanding role in the Medicare program, the studies in our review provide
useful context for understanding how well Medicare Advantage plans are serving
their enrollees relative to traditional Medicare. At the same time, data
limitations remain a significant concern.”
Analysis
As
noted in a separate KFF report, Medicare Advantage is projected to exceed
more than half of all Medicare beneficiaries as soon as next year. At the
same time, it is well documented that MA plans are overpaid, and such overpayments unnecessarily
drive-up programmatic spending. But what have Medicare beneficiaries and
the Medicare program as a whole gained from these overpayments?
Not
surprisingly, the insurance industry often paints MA as “better” for
beneficiaries than traditional Medicare, issuing statements such as “More than
28 million seniors and people with disabilities choose Medicare Advantage (MA)
because it delivers better services, better access to care, and better value”
(AHIP), and MA is “delivering better health outcomes, through better quality
care at a better cost for Medicare beneficiaries” (Better Medicare Alliance).
But
is Medicare Advantage
really “better” than traditional Medicare? According to
this KFF report and its analysis of recent studies, coupled with our own
experience serving Medicare beneficiaries who need care for significant
illnesses or injuries, the
answer is an unequivocal “no”.
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