Reviewed by Emily Henderson,
B.Sc.Mar 2 2021
More than one out of every 10 seniors (10.5%) enrolled in a
Medicare Advantage plan, also known as a Medicare managed care option, and
living in a rural area, switched to traditional Medicare during 2010-2016.
The switch was driven primarily due to low satisfaction with
care access, according to a study published this week in Health Affairs from
researchers at Drexel University's Dornsife School of Public Health. By
contrast, only 1.7% of rural traditional Medicare enrollees made the switch to
Medicare Advantage during this period.
The findings, among the first to look at rates of switching between
the two options among rural versus nonrural enrollees, found a similar, yet
more muted, effect among nonrural enrollees, with 2.2% of traditional Medicare
enrollees and 5% of Medicare Advantage enrollees making the switch.
Switching was most common among Medicare Advantage enrollees who
experienced higher costs, such as hospitalization or long-term facility stay.
Among those requiring more expensive services, rural enrollees were about twice
as likely to switch from Medicare Advantage to traditional Medicare as nonrural
enrollees (16.8% versus 8.3%), suggesting that limited provider options in
rural areas were a major factor leading consumers to change their coverage
plan.
We studied 11 factors that might make someone switch their
health insurance and found that much of this transfer from Medicare Advantage
to traditional Medicare among rural residents came from limited provider
availability. However, care quality or out-of-pocket costs played a limited
role. It's not that rural patients were sicker than nonrural patients, they
might just have a much tougher time than their counterparts did when it came to
finding an approved medical provider."
Sungchul Park, PhD,
Study Lead Author and Assistant Professor, Dornsife School of Public Health,
Drexel University
Unlike traditional Medicare, which is administered by the
Centers for Medicare and Medicaid Services, Medicare Advantage is operated by
private companies approved by the government. Both traditional Medicare and
Medicare Advantage include hospital (Part A) and medical (Part B) insurance.
However, funding for the two programs differs and influences how
they're delivered. In traditional Medicare, the federal government pays for
services performed, but the government pays Medicare Advantage insurers using
fixed, pre-negotiated rates. This creates incentive for Medicare Advantage
plans to implement cost-saving measures, such as programs to keep their
enrollees healthy, implement networks and require prior authorization
restrictions to care.
"Medicare Advantage plans might have lower premiums and/or
supplemental coverage in some areas, but that value is not enough for patients
in more restrictive provider networks that prevent them from accessing care
they need," said Park. "We found that levels of satisfaction with
out-of-pocket costs had little very little influence in patients who decided to
change their plan."
Data was gathered from a nationally representative sample of
seniors over age 65 from the Medicare Current Beneficiary Survey from
2010-2016, (expect for 2014, when data was not reported), including
demographics, socioeconomic characteristics, health data and satisfaction with
care. Rural residency was based on county-level 2013 data from the Department
of Agriculture.
The authors suggest the importance of developing policies to
incentivize the health care workforce to practice in rural areas. For example,
loan repayment or forgiveness programs may attract needed health care
professionals to areas of shortages.
Also, the federal government could consider changing Medicare
Advantage network adequacy standards for rural areas to make sure that there
are enough providers included. Finally, offering a rural payment add-on for
Medicare Advantage plans that operate in rural areas may improve access to
high-quality Medicare Advantage plans among rural enrollees.
Source:
Journal reference:
Park, S., et al. (2021) Rural Enrollees In Medicare
Advantage Have Substantial Rates Of Switching To Traditional Medicare. Health
Affairs. doi.org/10.1377/hlthaff.2020.01435.
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