Tag: Traditional Medicare

Medicare Advantage dental, vision and hearing benefits offer little value
Medicare Advantage plans advertise their “extra” benefits as a way to lure in new enrollees. But, new research published in JAMA Network finds that Medicare Advantage dental, vision and hearing benefits offer little value to enrollees. Enrollees have no better access to dental, vision and hearing benefits than people in traditional Medicare.

The most recent MedPAC data show that the federal government is spending 22 percent more per Medicare Advantage enrollee than for enrollees in traditional Medicare. The data are increasingly also showing that, notwithstanding the estimated $83 billion more the insurers offering Medicare Advantage received from the federal government in 2024, Medicare Advantage enrollees get fewer benefits than people in traditional Medicare.

For the most part, insurers offering Medicare Advantage only cover care for their enrollees from a restricted network of physicians and hospitals. In rural communities, people have to travel long distances to see a doctor or get treated at a hospital because their local providers are not in their Medicare Advantage plan network. And, the specialists qualified to treat certain conditions are also often not in-network.

Moreover, Medicare Advantage insurers often inappropriately delay and deny care to their enrollees, particularly when they have complex and costly conditions. The insurers’ financial incentive is to withhold care because the government pays them upfront regardless of the amount of money they spend on care. The less care they cover the more money they get to keep.

A team at Mass General Brigham looked at whether the “extra” benefits Medicare Advantage insurers offer add value. Insurers misleadingly claim that they give their enrollees more than traditional Medicare in the form of extra benefits. But, that is not true in fact.

Insurers often deny Medicare Advantage enrollees coverage for treatments that traditional Medicare covers. And, while insurers technically offer enrollees additional benefits, too often, enrollees are not aware of these benefits or the out-of-pocket costs present a barrier to care. The researchers found that fewer than six in ten enrollees knew their Medicare Advantage plan covered these “extra” benefits.

Between 2017 and 2021, people in traditional Medicare and Medicare Advantage spent about the same amount for dental, vision and hearing services, notwithstanding that Medicare Advantage plans claim to offer these benefits and traditional Medicare does not. They also received about the same number of services. There is no reason to be paying Medicare Advantage insurers more per enrollee than the government spends in traditional Medicare.

“Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” said first author Christopher L. Cai, MD. At best, people in Medicare Advantage are getting a discount of less than 10 percent on vision, hearing and dental treatment. Out-of-pocket costs are high, even with the benefits, and the panel of covered providers is narrow.

“Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” according to senior author Lisa Simon, MD, DMD, assistant professor in the Division of General and Internal Medicine at Brigham and Women’s Hospital. “Older adults and people with disabilities deserve better from Medicare.”

Here’s more from Just Care:
January 28, 2025
2025: Take advantage of the Medicare Advantage Open Enrollment Period
If you’re in a Medicare Advantage plan, you should seriously consider taking advantage of the Medicare Advantage open enrollment period between January 1 and March 31 that allows you to switch to Traditional Medicare (government-administered insurance coverage) or to a different Medicare Advantage plan. This right to switch out of your Medicare Advantage plan is a critical consumer protection.

Many people do not realize that there are few guarantees with Medicare Advantage. Between the time you sign up for a plan and the beginning of the new year, both the drugs and providers the plan covers could have changed significantly. So be sure to check. Moreover, you never know what illness you might be diagnosed with and whether your Medicare Advantage plan will cover the treatments your physicians recommend or deny them. And, most of the time, you will be faced with what could be harmful delays as a result of prior authorization requirements.

I’ve written at length about all the reasons not to enroll in a Medicare Advantage plan, especially if you have Medicaid or can afford the supplemental coverage that you need in Traditional Medicare to limit your out-of-pocket costs. Upfront costs in Medicare Advantage are lower than those in Traditional Medicare with supplemental coverage. But, if you get sick and need care–the reason you have health insurance–your out-of-pocket costs are likely to be a lot higher in Medicare Advantage than in Traditional Medicare.

Moreover, in a Medicare Advantage plan, you are at risk of not getting the care you need if you are diagnosed with a costly condition. The Office of the Inspector General has twice reported widespread delays and denials of care and coverage in most Medicare Advantage plans. Also, access to care is much simpler in Traditional Medicare than in Medicare Advantage.

In Traditional Medicare, your treating physicians decide the care you need without an insurance company second-guessing your doctor and profiting every time it denies you care. And, there are no prior authorization requirements, requiring you to wait before your care will be covered. Furthermore, you are covered for care from almost all providers anywhere in the US, whereas in Medicare Advantage, your insurer generally will only cover your care from a limited set of providers. And, in Traditional Medicare, with supplemental coverage, your costs are predictable and often very little.

Medicare Advantage HMOs restrict your coverage to the doctors and hospitals in their networks. You can go out of network for some coverage only if you’re in a PPO. But, even in a PPO, coverage tends to be limited and unpredictable. Driving your costs up further and/or endangering your health, Medicare Advantage plans usually impose prior authorization requirements before they will cover costly care. And, they inappropriately deny care, particularly to people with costly conditions–people needing rehab care, people with cancer and people with other complex care needs.

The Centers for Medicare and Medicaid Services, which oversees Medicare, should be protecting you from bad actor Medicare Advantage plans, but it cannot. It does not have the capability, the money, or the power to oversee the 4,000 Medicare Advantage plans, much less to hold them to account for their bad acts.

You should also bear in mind that you can’t count on the providers in Medicare Advantage directories actually being willing to see you. Multiple reports reveal “ghost” networks in some Medicare Advantage plans. As well, I’ve reported many times in Just Care on hospitals terminating their Medicare Advantage contracts, leaving Medicare Advantage plan enrollees scrambling to find alternative care or forced to drive long distances for inpatient services.

N.B. If you want to switch to Traditional Medicare, note that you will need supplemental coverage (Medigap) to protect you from high out-of-pocket costs. Traditional Medicare does not have an out-of-pocket limit. If you don’t have Medicaid or coverage from a former employer, make sure you can buy it in the individual market. In most states, insurers selling Medicare supplemental coverage are not required to sell you a policy, with some exceptions, including when you first enroll in Medicare at age 65 or later.

Here’s more from Just Care:
January 21, 2025
Insurers pay Medicare Advantage brokers to steer you away from Traditional Medicare
Medicare Advantage insurers incentivize brokers to mislead people about their Medicare choices. A number of Medicare Payment Advisory Commission (MedPAC) Commissioners want to stop Medicare Advantage insurers from paying brokers more to steer people into their Medicare Advantage plans than to steer people into Traditional Medicare, Joyce Frieden writes for MedPage Today.

Medicare insurance brokers have no financial incentive to help people understand why Traditional Medicare might better meet their needs, providing easy access to care from doctors and hospitals across the US. They are not paid to do so. MedPAC Commissioner Lynn Barr called out the reality that these insurers are capitalists and said we need to “stop pretending they’re going to do things out of the goodness of their heart.”

In a series of 24 focus groups, MedPAC staff learned that few people use independent informed sources to make their Medicare choices. Many rely on insurance brokers, who are biased, or friends and family, who might not understand the tradeoffs between Medicare Advantage and Traditional Medicare. Few contact their State Health Insurance Assistance Program (SHIP), which provides free unbiased advice.

Brokers are often not paid to enroll people in standalone Part D drug plans that people with Traditional Medicare use. But, they earn over $600 to enroll a person in a Medicare Advantage plan and $300 if the person stays in the plan. Insurers pay brokers only a fraction of that amount to enroll people in a Medicare supplemental insurance plan (“Medigap”), and in cases where the person has a disability, they sometimes pay no commission at all.

The MedPAC Commissioners recognize that people need much more help choosing between Traditional Medicare and a Medicare Advantage plan. They also expressed concern that Medicare Advantage provider directories tend to include a lot of misinformation, making it impossible to know which physicians are in the insurers’ network.

Also keep in mind: You have no good way to distinguish the good Medicare Advantage plans from the bad ones. Medicare’s five-star rating system should steer you away from plans with fewer than five stars. But, even the five-star plans could have high rates of inappropriate delays and denials of care, high mortality rates, and large administrative and financial obstacles to care. The government doesn’t factor delays and denials into the star ratings. You are forced to gamble with your health.

Here’s more from Just Care:
October 14, 2024
It’s Medicare open enrollment season, here’s what to do and not do
During this Medicare Open Enrollment period between October 15 and December 7, here’s what to know:
People on limited incomes can’t make a meaningful Medicare choice.

Only Traditional (Original) Medicare gives you the freedom to receive the care you need from the doctors and hospitals of your choice. But it lacks an out-of-pocket cap, so it comes with financial risk unless you also have supplemental coverage, which can be expensive.

Medicare Advantage is always a gamble. MA plans can overrule your doctor and deny you the care you need.
If you can’t afford Traditional Medicare, call your member of Congress and tell them to add an out-of-pocket cap.

Whether you’re in Traditional Medicare or a Medicare Advantage plan, your Medicare Part B premiums will increase and your Part D prescription drug coverage will change in 2025. You should compare your prescription drug Part D options. And, you should be aware that sometimes it is less costly to get your drugs from Costco or another low-cost pharmacy than to get them through your Part D insurance.

To ensure you get covered for the care you need from the doctors and hospitals you want to use, without administrative hurdles, make sure you are enrolled in Traditional Medicare, the government-administered Medicare program.Only Traditional Medicare gives you the freedom to receive the care you need from the doctors and hospitals of your choice. Unlike Medicare Advantage, Traditional Medicare allows you and your treating physician to decide the care you need without second-guessing. And, with supplemental insurance you have few if any out of pocket costs. But because TM lacks an out-of-pocket cap, millions of Americans can’t afford it.

If you cannot afford Traditional Medicare or you cannot get supplemental coverage to fill coverage gaps, you have no choice but to enroll in Medicare Advantage. Medicare Advantage is always a gamble. You cannot make a meaningful choice of a Medicare Advantage plan. MA plans can overrule your doctor and deny you the care you need. Reports show widespread and persistent delays and denials of care and coverage in many MA plans. You cannot avoid that. The best you can do is pick a plan with a five-star rating and hope you don’t get sick.

Don’t assume that anything about your Medicare Advantage plan will remain the same in 2025. Your physicians and hospitals could be leaving the network. Your costs could be rising. Your prescription drug coverage could be changing. Review all your Medicare options carefully, including Traditional Medicare.

How to choose a Medicare Advantage plan? You can’t make an informed choice or avoid bad actor MA plans.You can’t know in advance whether an MA plan is engaged in widespread and persistent inappropriate delays and denials of care, as many of them are. The government cannot protect you from Medicare Advantage bad actors that do not cover your Medicare benefits, as required. The best you can do is pick a plan with doctors and hospitals you want to use in its network and hope they don’t leave. You can’t count on them staying. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care. Unfortunately, in Medicare Advantage, you are gambling with your health care and could incur thousands of dollars in out-of-pocket costs. Insurers have a financial incentive to deny care; the less care they cover, the more they profit. Don’t be seduced by “extra” benefits, which are often very limited and can come with high out-of-pocket costs.

Keep in mind that when you need costly and complex care, your Medicare Advantage plan is likely to require prior authorization and could overrule your treating physician, denying you coverage. You can appeal, but you might need to pay out of pocket for the full cost of your care. Even when Medicare Advantage plans approve your care, they generally force you to go through hoops and face delays before they will cover your care.

Don’t trust an insurance agent’s advice about your Medicare options. Unfortunately, insurance agents are paid handsomely to steer you away from Traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. You can’t know whether you can trust an insurance agent.

If you have Medicare and Medicaid:
- You will have much easier access to physicians and inpatient services in Traditional Medicare than in a Medicare Advantage plan if you need costly health care services or have a complex condition. And, you will have no out of pocket costs.
For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a State Health Insurance Assistance Program (SHIP).

Here’s more from Just Care:
October 9, 2024
To protect older adults and people with disabilities, Congress must add an out-of-pocket cap to Traditional Medicare
To promote health equity, meaningful choice, competition between Traditional Medicare and Medicare Advantage plans, as well as to protect older adults and people with disabilities, Congress should limit people’s out-of-pocket expenses in Traditional Medicare by adding an out-of-pocket cap. Congress also should eliminate the enormous overpayments to Traditional Medicare in order to ensure the sustainability of the Medicare Trust Fund and bring down Part B premiums.

Health equity: People of color and people with limited means are usually forced to choose among Medicare Advantage plans without being able to know which will cover their care appropriately. They are at serious risk. They are often locked into Medicare Advantage plans with very narrow networks and excessive prior authorization requirements because Traditional Medicare does not have an out-of-pocket limit and they cannot afford supplemental coverage.

Medicare Advantage insurers are able to decide which Medicare Advantage plans offer more or fewer prior authorization requirements and better provider networks; but, there’s no way for consumers to know. The Medicare Advantage star-rating system is a farce; five-star plans can be bad actors, with ghost networks and widespread inappropriate delays and denials of care. The Centers for Medicare and Medicaid Services (CMS) has no way to protect vulnerable Medicare Advantage enrollees. Without an out-of-pocket cap in Traditional Medicare, they generally do not have it as an option.

Choice: An out-of-pocket cap in Traditional Medicare would give people a meaningful choice of Traditional Medicare. It would allow people to enroll in Traditional Medicare without financial risk. Low and middle-income people and people of color lack this choice today because they cannot get the supplemental coverage they need to protect themselves financially. Supplemental coverage is either unaffordable or unavailable.

Indeed, today, people living in communities that insurers do not see as profitable, typically lower-income communities, can be left without any MA plan options and no meaningful Traditional Medicare option.

Competition: An out-of-pocket cap would help level the playing field between Traditional Medicare and Medicare Advantage, driving competition.

Cost savings: In 2024, Medicare Advantage plans cost as much as 22 percent more per person than Traditional Medicare, eating into the Medicare Trust Fund and driving up Part B premiums. Traditional Medicare is far more cost-effective than Medicare Advantage. An out-of-pocket cap in Traditional Medicare would enable more people to enroll, reducing Medicare spending.

Coverage: An out-of-pocket cap would protect people in Medicare Advantage plans who are too often inappropriately denied the reasonable and necessary services to which they are entitled. It would enable them to switch to Traditional Medicare. Today, the government cannot protect them from bad actor Medicare Advantage plans. The most vulnerable Medicare subpopulations are hardest pressed to navigate the rules and narrow networks in Medicare Advantage and get the care they need.

Here’s more from Just Care:
September 11, 2024
New report shows Medicare Advantage might not save you money
Many people say they enroll in Medicare Advantage–Medicare coverage through private health insurers- thinking it is a lower cost alternative to Traditional Medicare. Certainly, the Medicare Advantage plans want you to think that. But, a new report in the Annals of Internal Medicine by Sungchul Park, Amal Trivedi, and David Meyers shows that people in Medicare Advantage face about the same costs as people in Traditional Medicare; overall, the difference in spending is a wash!!!

The researchers looked at costs for people in Traditional Medicare as compared to costs of people who switched from Traditional Medicare to Medicare Advantage. They found that “[d]ifferences in financial outcomes between beneficiaries who switched from TM to MA and those who stayed with TM were small. Differences in financial burden ranged across outcomes and did not have a consistent pattern.” The findings are particularly significant because people too often assume they will save money in Medicare Advantage and fail to appreciate the challenges they could face getting the care they need from the physicians and hospitals they want to use in Medicare Advantage.

To be clear, there’s no question that if you need few or no health care services, you will have few if any costs in a Medicare Advantage plan. But, you would have few if any costs in Traditional Medicare as well if you did not buy supplemental coverage. The question you should consider when deciding whether to enroll in a Medicare Advantage plan is whether you are willing to trade the cost of supplemental coverage in Traditional Medicare to pick up your out-of-pocket costs for a serious gamble as to whether you will be able to get the care you need at a price you can afford in a Medicare Advantage plan.

There are four big issues facing people in Medicare Advantage that people in Traditional Medicare do not face.
1. Even though you are supposed to get the same benefits in Medicare Advantage as in Traditional Medicare, Medicare Advantage plans often inappropriately delay and deny care, forcing you to get prior authorization before receiving services and, sometimes, challenge denials of care your treating physicians say you need. In some cases, your only choice is to pay out of pocket for the full cost of those services.
2. Traditional Medicare covers your care from almost any physician or hospital you want to use. Medicare Advantage plans restrict your access to physicians and hospitals, sometimes not covering care in cancer centers of excellence or from top specialists. In some cases, your only choice is to pay out of pocket for the full cost of services from the physicians or hospitals you want to use.
3. Traditional Medicare covers your care anywhere in the United States. So, if you are traveling or have a second home or want to receive your care away from home and near a friend or family member, Traditional Medicare will cover it. But, if you are in a Medicare Advantage HMO, it will only cover your care out of your area if it is an emergency. And, if you are in a Medicare Advantage PPO, it will only cover at best 60 percent of the cost of your care out of your area, except in emergencies.
4. Some Medicare Advantage plans might meet your needs and others might not. But, the data is not available to let you know which ones are better than others. You should avoid all Medicare Advantage plans that are not five stars, but five star plans could still have high denial, high delay and high mortality rates.
Here’s more from Just Care:
July 2, 2024
People with Medicare increasingly going without private supplemental coverage
A new report from the US Census Bureau reveals that an increasing number of people with Medicare are going without private supplemental coverage. While the report does not look into why this is the case, more people with Medicare are opting for Medicare Advantage plans, which don’t allow people to have supplemental coverage. In addition, more people in Traditional Medicare are not buying supplemental coverage, either because it is not available to them or it is unaffordable.

While the Census Bureau does not explore the risks of people with Medicare not having supplemental coverage, the risks are significant. Without supplemental coverage, out-of-pocket costs in the form of deductibles and copays are often unaffordable. People of color, people with low incomes and people in poor health are particularly at risk.

People enrolling in Medicare Advantage plans often mistakenly believe they are saving money over enrolling in traditional Medicare, when in fact they can easily spend a lot more on their care in Medicare Advantage than in traditional Medicare with supplemental coverage. Comprehensive Medicare supplemental coverage costs around $2,500 a year, while out of pocket costs in Medicare Advantage for people who need a lot of care can easily be $5,000 a year for in-network care alone. Unfortunately, we can’t predict when we will be diagnosed with a costly condition or be hit by a car and need costly care.

People in traditional Medicare without supplemental coverage pay about 16 percent of the cost of their care; they have no out-of-pocket cap. That can be prohibitively expensive for most people, leading them to opt not to get care. Traditional Medicare should have an out-of-pocket cap.

The maximum out-of-pocket cap in Medicare Advantage can be as high as $8,850 this year for in-network services. Beyond this out-of-pocket limit, because Medicare Advantage plans too often inappropriately delay or deny care or have restricted networks that will not allow you to see the doctors you need to see, you can be liable for the full cost of care you need. So, whether you are in traditional Medicare or a Medicare Advantage plan, out-of-pocket costs can be thousands of dollars without supplemental coverage. Most people with Medicare delay or forgo care when their costs are unaffordable.

The Census Bureau report shows that in the five years between 2017 and 2022, the rate of people with Medicare with supplemental coverage fell more than 8 percent from 47.9 percent to 39.6 percent.

Medicare should have far lower out-of-pocket costs, both to promote health equity and to ensure every older adult and person with a disability has access to the care they need, regardless of their ability to pay for it.

Here’s more from Just Care:
April 23, 2024
Primary care in Medicare Advantage: A crapshoot
Don’t join a Medicare Advantage plan because you believe it will offer good primary care. According to a new report by the Commonwealth Fund, primary care could be good and it could be bad in Medicare Advantage, depending upon the plan you are enrolled in and the primary care physician you use. What’s for sure is that if you get sick and need costly care, you are taking a huge gamble with your health in Medicare Advantage.

For sure, some if not most insurers offering Medicare Advantage plans want you to see a primary care doctor. That’s how they can most easily add diagnoses codes to your medical records in order collect more money from the government for your care. But, it’s not clear whether seeing a primary care physician in Medicare Advantage will improve your health or not.

We know very little about whether a particular Medicare Advantage plan will ensure a primary care doctor coordinates your care in ways that keep you healthy. The government pays Medicare Advantage plans upfront regardless of whether they coordinate care. So, they could advise their primary care doctors to spend little time with you or pay these physicians more if they don’t refer you for specialty care or refer you to specialists who cost less and provide lower quality care.
The Commonwealth Fund examined whether primary care physicians treat Medicare Advantage patients in different ways from physicians who treat Traditional Medicare patients. They found that, overall, there were not many meaningful differences between the care primary care physicians provide patients in Traditional Medicare as compared with the care they provide patients in Medicare Advantage.

Unfortunately, “overall,” is not really helpful in this analysis. It’s like saying that “overall” restaurants in NYC are fine. The question for people with Medicare is which are the good Medicare Advantage plans and which ones should be avoided. This Commonwealth Fund survey does not provide that information.

In short, it seems not to be the case that insurers are making it easier for their primary care physicians in Medicare Advantage to manage and coordinate care than Traditional Medicare.

Here’s more from Just Care:

Six reasons you need a primary care doctor in this age of specialization

Four questions to ask yourself about your primary care doctor

Five tips for talking to the people you love about their health

2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan

Get the preventive care you need: Medicare pays for it
March 25, 2024
What could a better Medicare look like?
A new report from the Center for American Progress focuses on Medicare as a great American success story. Yet, it recognizes that Medicare needs improvements for its long-term sustainability, for easy access to affordable care for the tens of millions of older adults and people with disabilities it serves, for promoting health equity, for improving population health and more.

Traditional Medicare comes with high cost-sharing and no out-of-pocket cap, as well as a fragmented structure that requires the separate purchase of Part D prescription drug coverage and supplemental coverage to fill gaps in Medicare. Medicare Advantage comes with a defective payment system that leads to massive overpayments and incentivizes insurers to design their health plans to attract the healthy and avoid the sick in order to maximize profits.

The authors of this report believe that strengthening and improving Medicare benefits would offer a strong counterbalance to opposition from health insurers over ending their overpayments. The goal therefore is to link Medicare enhancements to reform of the Medicare Advantage payment system.

The new Medicare would guarantee people easy affordable access to the care they need, including prescription drugs and primary care, while promoting population health and health equity. In Medicare Advantage, people and providers often face inappropriate denials of care and coverage. People also face inadequate provider networks that keep them from getting the care they need.

A stronger Medicare would also cover in-home and community long term services and supports. Today, Medicare only covers skilled nursing home care for people who have been hospitalized for at least three days prior to admission and need daily skilled care. And, coverage is for no more than 100 days. Medicare Advantage plans tend to limit that coverage to a few days at most.

Vision, hearing and dental care would also be part of the Medicare benefit package. While some Medicare Advantage plans claim to cover one or more of these services, people in Medicare Advantage don’t tend to receive them any more than people in Traditional Medicare because out-of-pocket costs are still very high and network providers are limited. People in Medicare Advantage pay 65 percent of vision costs, 76 percent of dental costs, and 79 percent of hearing costs.

To lower administrative expenses for providers and payers and ensure people in Medicare Advantage actually get the Medicare benefits to which they are entitled, the authors propose that Medicare Administrative Contractors—which today process claims in traditional Medicare—do so for Medicare Advantage plans as well.

The authors further propose lower out-of-pocket costs in traditional Medicare. Lower costs would make it much easier for people to move from Medicare Advantage to Traditional Medicare. Currently, most people are locked into Medicare Advantage because they cannot afford or cannot secure supplemental coverage to limit their financial risk in traditional Medicare, which lacks an out-of-pocket cap.

With regard to prescription drugs, the authors say that drug pricing must be fair and reward meaningful innovation. They point out that insurers offering Medicare Advantage plans create drug formularies that are especially costly for people with expensive conditions in order to keep these high-cost individuals from enrolling. The authors recommend no cost or low copays for drugs that are of critical benefit to patients.

The authors envision promoting population health through “a payment policy oriented toward medical and social needs [that] would pay providers more for [a] patient[s] [who is vulnerable] to enable what [he] really needs—for instance, his clinic builds a diabetes registry, a population health manager identifies that he has not had a recent visit, a community health worker calls him and helps him arrange a free ride to the clinic through a local program, and his doctor checks his lab work and starts him back on medications for his diabetes. A nurse calls him afterward to make sure he was able to start taking the medication and to review his follow-up plan. The infrastructure that helps this patient—chronic disease registries, population health managers, community health workers, community partnerships, team-based care—enables the health care organization to manage population health for the community it serves.”

Here’s more from Just Care:
March 18, 2024
New poll confirms serious access to care concerns in Medicare Advantage
While all insurers offering Medicare Advantage (MA) profit more the less care they deliver, every Medicare Advantage plan is different; we should not generalize about them. We know that access to care can be a serious issue in MA, with some insurers using artificial intelligence to deny care, others relying on prior authorization requirements to delay and deny care and others offering provider networks that do not meet enrollees’ needs. A new Commonwealth Fund survey confirms that access to care continues to be a far more serious concern for MA enrollees than for Traditional Medicare (TM) enrollees.

The Commonwealth Fund survey of more than 3,200 people with Medicare found that more than one in five people (22 percent) enrolled in Medicare Advantage reported delays in receiving care, as compared with one in eight (13 percent) enrolled in Traditional Medicare.

Wait times to see physicians did not vary between people in Traditional Medicare and people in Medicare Advantage. But, one in three people polled said they waited more than a month to see a physician.

People in MA reported significantly higher financial barriers to care than people in Traditional Medicare. Twelve percent of people in MA faced cost barriers to care, in the form of either a deductible or a copay, as compared with seven percent of people in Traditional Medicare. The five percent difference is especially telling, given people in MA overall are healthier than people in TM.

Satisfaction was relatively the same for people with Traditional Medicare and Medicare Advantage.

Here’s more from Just Care:
February 27, 2024