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Making the Case for Medicare Advantage

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Government watchers know there are two parts to federal policy. First, there is the law passed by Congress. Second, there is how agencies implement the law. For Medicare Advantage, congressional support remains robust – but the program’s future lies squarely with the Centers for Medicare and Medicaid Services (CMS).

CMS reviews and sets rates, which is an important milestone for beneficiaries. Adjustments directly affect coverage. Health plans must have sufficient funding to remain in the market and provide the comprehensive benefits seniors and disabled individuals—including 204,000 Virginia residents—rely on.

This year’s process will take on greater-than-usual importance. With new faces occupying key posts, senior CMS officials must be made aware of the program’s many benefits so they understand why 90 percent of enrollees are happy with their Medicare Advantage plans.

Choice plays a big part in satisfaction levels. Medicare Advantage enrollees shop for a health plan that best meets their needs. Whether a beneficiary wants to avoid monthly premiums, opt for a plan a current doctor accepts, or match the pharmaceutical formulary to their treatment, a suitable product is likely available in the Medicare Advantage market.
Beneficiaries also want value. While all Medicare Advantage health plans are required to match traditional Medicare’s benefits, Medicare Advantage consistently incorporates much more. Enrollees gain access to comprehensive coverage at a very affordable cost, often just a $5 co-pay for most services.

That includes a wide array of preventive care. Plans assist enrollees in taking control of their health with health screenings, disease management programs, nurse help lines, and in many cases, free senior-friendly fitness memberships to help maintain strength, cardiovascular health, and range of motion.

The array of services combined with the financial protections—including a cap on annual out-of-pocket expenses—help explain the high enrollment in Medicare Advantage across a diverse population of beneficiaries. In fact, approximately 45 percent of Hispanic and 30 percent of African-American beneficiaries choose Medicare Advantage, as do 37 percent of beneficiaries with incomes less than $20,000.

The true significance of Medicare Advantage, however, can be found in better health. The American Journal of Managed Care found Medicare Advantage’s hospital readmission rate to be 13 percent to 20 percent lower than traditional Medicare. And Medicare Advantage enrollees make more appropriate use of services, according to Health Affairs. They also enjoy lower incidences of emergency services, fewer hip replacements, and higher rates of coronary bypass surgery in accordance with national guidelines.

These statistics indicate enrollees are receiving better care. They’re staying more nimble, so they avoid falling. Post-hospital care is preventing complications. And disease management and appropriate medical interventions are reducing crisis events.

Better health is good for patients – and the federal budget. This fact has earned Medicare Advantage broad support from lawmakers in both parties. Elected officials are once again stepping forward. Already a bipartisan groups of 65 U.S. Senators, including Virginia’s Mark Warner, sent a letter to CMS in support of Medicare Advantage. For the 18 million Americans who choose the program – that is a welcomed start.

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