Medicare Advantage: Too Big For Its Own Good?

Medicare Advantage has gained substantial popularity over recent years, but its growth may prove to not be the best trajectory for consumers.

Medicare Advantage (MA) already holds about 30 million beneficiaries, and that number is only expected to grow. A new report by the New England Journal of Medicine is raising some concerning questions about the quality of care, cost considerations, and general strain of an overpopulated program.

The study shows that since 2010 MA has been slowly catching up to traditional Medicare enrollment numbers and is now on track to surpass it in 2024.

Why the Growth?

The attraction of MA plans stems from a few items. Beneficiaries consistently cite that these plans have lower cost-sharing, support generous supplemental benefits, and put limits on out-of-pocket spending. Another attraction is the increasing rebates, as well as the supplemental benefits they fund, which are also expected to grow over the next decade.

But outside of the attractive benefits and costs, aggressive broker marketing is also at play here, and it is prone to abuse. Brokers are offered higher commissions and other financial incentives by insurers to enroll consumers in MA plans, versus private insurance plans that supplement traditional Medicare.

Another reason? The simplicity in the plan. While traditional Medicare forces patients to split up their plan in various different parts to receive comprehensive coverage, MA plans keep it short and sweet with one comprehensive plan and one deductible.

The Current and Rising Issues

The Cost

The issues the system is seeing emanate from its overpopulation and costs. Can Medicare afford MA?

According to the Medicare Payment Advisory Commission (MedPAC), MA plans will cost Medicare approximately $27 billion more for 2023 than for the same patients in traditional Medicare. The program costs the Federal Government 6% more per enrollee, and that’s before we even account for the general favorability of MA. This hike in cost results in higher federal expenditures and deficits and higher costs to all beneficiaries.

Solutions? There’s the option to trim Medicare benefits and increase federal taxes, but these aren’t exactly favorable discussions. Problems will inevitably arise.

The Quality

While the quality of MA plans seems to be neck and neck with traditional Medicare, there are a few areas of concern, the NEJM study said. On the whole, in some parts of the country MA has shown less disparities in quality, but the quality of care for some medical services may be poorer than traditional Medicare. However, the data here is limited.

Concerns have also arisen about provider networks, specifically for top tier providers of cancer care. Evidence shows that accessibility to behavioral and mental health is also an issue for both MA and traditional Medicare, many psychiatrists will opt out of traditional Medicare and very few remain in networks of MA plans.

Although MA beneficiaries seem to be using fewer services and running into fewer costs, care quality is somewhat unclear. The NEJM study reported, “[...] recent evidence suggests that beneficiaries in Medicare Advantage plans who use postacute services have less favorable outcomes than those in traditional Medicare.”

Keep in mind this data is limited, unclear, and shows that quality of care is an area that will need to be further examined for comparison.

The Road Ahead

MA has presented a few major problems for an important national program, and working to change them may not be the easiest path. MA holds a massive number of older voters that might make it politically difficult to change the course of the program.

However, as the study suggests, as the program continues to grow, federal authorities and MA plan stakeholders must rise to the challenge of creating a program that is affordable, high-quality, free-of-abuse, meets the needs of consumers, and truly benefits them.