A new study in the American Journal of Preventive Medicine looks at out-of-pocket costs for people in Medicare Advantage plans and how they affect access to care. There is inexcusably little information available on what you will pay on average out of pocket in a particular Medicare Advantage plan in a given year, let alone for specific services. This study reports that some Medicare Advantage plans voluntarily paid the full cost of care for hospitalized members with COVID-19–although it does not say how many–and is concerned about Medicare Advantage plan members who went without COVID-19 treatment because of the out-of-pocket costs.
To get a sense of what people in Medicare Advantage would pay for COVID-19 treatment, researchers looked at 2018 data to determine how much out-of-pocket costs could be for people hospitalized with the flu. The researchers found that of 14,278 people in a Medicare Advantage plan over 65, hospitalized with the flu in 2018, paid an average of $989 on deductibles, copays and coinsurance. Hospitalizations averaged around six days. Averages are a bit misleading as there were a small group of people in certain Medicare Advantage plans whose out-of-pocket costs were far higher. We don’t know which Medicare Advantage plans charged more and which charged less.
Congress did not mandate that Medicare Advantage plans cover the full cost of COVID-19 treatment, only testing. It is not clear why it did not insist on full payment for COVID treatment given that out-of-pocket costs undermine access to needed care. It should not have cost more; the federal government was overpaying Medicare Advantage plans, paying them as if people were using the typical number of health care services at a time when they were using far fewer health care services.
The researchers believe that it is critical that Medicare Advantage plans cover the full cost of COVID-19 treatment to ensure that everyone who needs care receives it. In 2018, four in ten people did not have $400 in the bank to pay for an emergency.
Of note, the researchers only looked at some Medicare Advantage data and were unable to know for nearly three in four people studied whether they were enrolled in a Medicare HMO or Medicare PPO. The data is incomplete.
Leave a Reply