Portrait of completely satisfied senior man sitting at home with walking stock and smiling.Portrait of nice … [+]
Within the sometimes bleak landscape of American medical health insurance coverage—which 71% of Americans rate as fair or poor—there could also be a vibrant spot: Medicare Advantage.
Recent research, released today from eHealth (NASDAQ: EHTH), shows that individuals enrolled in Medicare Advantage plans are highly satisfied with what they’ve got.
Amongst individuals who had who purchased a Medicare Advantage plan through eHealth’s website, 88% were very or somewhat satisfied with their coverage and just 6% were dissatisfied. Nearly the identical percentage (86%) said they might recommend Medicare Advantage to a friend or member of the family; only 3% said they might not.
Medicare Advantage, also generally known as Medicare Part C, combines Original Medicare—Parts A and B which cover hospitalizations and outpatient care—with other advantages, often including Part D prescription coverage and extras resembling dental, vision, hearing, and fitness advantages.
Nearly half (46%) of survey respondents opted for Medicare Advantage because they wanted all their Medicare advantages in a single plan.
Amongst those that had previously been enrolled in other sorts of Medicare coverage, 61% said they preferred Medicare Advantage and 24% said they were just as satisfied with Medicare Advantage as they’d been on other Medicare coverage.
Specifically, 59% of respondents who had purchased Medicare Complement plans—also generally known as Medigap—were more satisfied with their Medicare Advantage plan. Two-thirds (67%) of those said Medigap was too costly. One-quarter said they preferred Medicare Advantage because Medigap doesn’t offer drug coverage.
Other reasons respondents selected to enroll in Medicare Advantage included coverage of preferred doctors, hospitals, and pharmacies; prescription drug coverage; and reasonably priced monthly premiums.
Yet a few of the exact same motivations for enrolling in Medicare Advantage were also the highest reasons cited among the many minority of respondents who reported being dissatisfied with Medicare Advantage. For instance, 29% of dissatisfied respondents blamed their dissatisfaction on lack of coverage for his or her preferred doctors, hospitals, or pharmacies. One other 22% pointed to lack of prescription drug coverage.
The survey also found a high degree of price sensitivity amongst respondents. Nearly half (48%) said they couldn’t afford to pay any monthly premiums and one other 25% said they’d only have the opportunity to afford monthly premiums of lower than $50. Three-quarters (74%) reported that they may only afford annual out-of-pocket costs of $1,000 or less.
Those findings may help explain the growing popularity of Medicare Advantage plans.
In 2021, 26 million people—42% of all Medicare beneficiaries—selected Medicare Advantage. Medicare Advantage enrollment has greater than doubled prior to now ten years.
Based on the Kaiser Family Foundation, most (59%) Medicare Advantage plans with prescription drug coverage available on the market in 2022 charged no additional monthly premiums (beyond the usual Medicare Part B premium from Original Medicare). Nearly all (98%) Medicare beneficiaries had access to at the least one zero-premium Medicare Advantage option that included prescription drug coverage.
These are popular options. Nearly two-thirds (65%) of enrollees have chosen zero-premium plans. One other 20% pay lower than $50 monthly for his or her Medicare Advantage plan with prescription drug coverage.
The Medicare Advantage picture is just not entirely rosy, though.
A federal report released in April 2022 suggested that Medicare Advantage plans could also be delaying or denying medically crucial care. A review of denied claims showed that 13% met Medicare coverage criteria, suggesting that Medicare Advantage plans were applying additional criteria not present in the Medicare rules. Moreover, the review found that some requests for added documentation were unnecessary. These findings suggest that Medicare Advantage plans were creating undue burdens on patients to receive needed care.
The newest report was consistent with a 2018 review which high levels of successful appeals. Of denied claims that beneficiaries tried to appeal, 75% of denials were overturned, indicating they might have been inappropriately denied in the primary place.
In eHealth’s survey, respondents reported relatively few coverage denials. Overall, 13% had had a claim or prior authorization request denied. Many fewer had been denied coverage for a particular prescription (3%), visits with a particular doctor (2%), or coverage for hospitalization (1%).
Of those that’d received denials, 43% said the rationale was that the requested service was excluded from their plan coverage and 15% said the denial was because their request was deemed to not be medically crucial. Ultimately, 15% reported that the unique denial was eventually overturned and paid by their insurer.
Overall, the eHealth results reflect well on Medicare Advantage as an option. Most (61%) survey respondents said they see Medicare Advantage of a great example of public/private cooperation.
Bob Rees, vice chairman of Medicare sales for eHealth, described the advantages of mixing government with private sector players within the Medicare Advantage market. The truth is, he says, it’s a part of this system’s success.
“On the one hand, private sector efficiencies keep costs down and there’s quite a lot of convenience in having all of your coverage wrapped up in a single plan. Then again, private insurers can limit beneficiaries to receiving care inside their doctor and hospital networks,” Rees said. “There’s at all times room for improvement but it surely’s necessary to take heed to the buyer and understand what works and what doesn’t. As shown in our report, for the strong majority, affordability and convenience trump other considerations.”