This week we are reading the Medicare Advantage Checkup from the New England Journal of Medicine, details on how patients in Mississippi have been impacted by hospitals dropping Medicare Advantage agreements, and how new Medicare Advantage benefits may be hard for seniors to find.
Medicare Advantage Checkup | The New England Journal of Medicine | November 14, 2018
The emerging role of Medicare Advantage, the private-plan alternative to traditional Medicare, is gradually changing the Medicare program in ways that have important implications for beneficiaries, providers, and spending. Fueled by policy changes adopted by both Democrats and Republicans, enrollment in Medicare Advantage plans has more than tripled since 2005, from approximately 6 million to 20 million beneficiaries. Between 2018 and 2028, Medicare Advantage enrollment is projected to rise from 34% to 42% of the Medicare population (Figure 1). At the same time, federal spending on behalf of Medicare Advantage enrollees is projected to grow from approximately $200 billion to more than $580 billion (not including additional Medicare spending associated with coverage of prescription drugs under Medicare Part D).1
In this article, we begin with a brief comparison of Medicare Advantage relative to traditional Medicare. We then examine the extent to which the Medicare Advantage program is achieving goals with respect to benefits and out-of-pocket costs, plan choice, federal spending, and quality.2,3 We highlight areas in which more evidence is needed to better understand the implications of the shift from traditional Medicare toward private-plan enrollment, and we identify ongoing challenges.
Hospitals dropping Medicare Advantage agreements leaves patients in lurch | Mississippi Clarion Ledger | October 29, 2018
Hospitals in Tupelo and Pike County are ending Medicare Advantage agreements, forcing patients to travel elsewhere or seek other plans before a Dec. 7 deadline.
“The underlying issue is that health providers, whether doctors or hospitals, are demanding more payment for their services rendered to those on Medicare, and the Medicare Advantage plans are refusing to pay more,” said Mississippi Insurance Commissioner Mike Chaney.
North Mississippi Health Services, which includes North Mississippi Medical Center in Tupelo, is ending its network agreement with Humana Medicare Advantage plans at the end of the year after negotiations failed. This affects 4,500 patients. Southwest Health System in Pike County is ending its agreement with Wellcare Medicare Advantage, which includes 800 patients.
Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find | Kaiser Health News | November 9, 2018
For some older adults, private Medicare Advantage plans next year will offer a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.
But the new benefits will not be widely available, and they won’t be easy to find.
Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.
That means even for the savviest shoppers it will be a challenge to figure out which plans offer the new benefits and who qualifies for them.