All beneficiaries of Medicare can enroll in Medicare Advantage as an alternative if they need private insurance. Currently, Medicare Advantage makes up over one-half all individuals enrolled in Medicare. Estimates from the Center for American progress show that the Centers for Medicare and Medicaid Services overpays Medicare Advantage plans by between 22% to 39%. This year, overpayments total between $83 billion and $127 billion.
This is despite the fact that there’s no substantial evidence that this program promotes health equity for its enrollees or enhances health-care quality. Considering this, there is need for the Centers for Medicare and Medicaid Services (CMS) to exercise oversight over Medicare Advantage.
While some steps have been taken to bring more accountability and transparency to the program, data gaps still exist that limit regulators’ ability to effectively carry out their duties. We look at some of these gaps below.
Use of supplemental benefits
These benefits include fitness benefits and dental coverage, which are marketed extensively under Medicare Advantage. Despite this, there is a lack of data on the use of these benefits, with available research suggesting that coverage under this plan for hearing, vision and dental services hasn’t resulted in better access for beneficiaries.
Disenrollment rates
Understanding the health characteristics and demographic of enrollees on Medicare Advantage who switch between plans or disenroll from conventional Medicare may help highlight alarming patterns while ensuring plans under Medicare Advantage are operating in a way that is committed to equity.
Enrollee out-of-pocket cost expenditure data
Individuals who would like to enroll to plans under Medicare Advantage need to be able to compare offerings under different plans, particularly when it comes to actual out-of-pocket spending. At the moment, this information is not available to the public, despite CMS collecting it annually.
This data will enable researchers to also analyze out-of-pocket spending for both traditional Medicare and Medicare Advantage beneficiaries annually.
Prior authorization
Insurance companies are required to obtain advance approval for specific medical care or drugs as a condition for payment under this tool. Requirements under prior authorization can place additional burden on providers of healthcare services, with the wait time between approvals also resulting in actual harm to patient health.
Beneficiaries under these plans need to know the role prior authorization plays when it comes to enrollment decisions.
By addressing these shortcomings and publicizing data on prior authorization, the CMS would make it easier for prospective enrollees to consider all data when deciding on an insurance plan.
Overall, data gaps under Medicare Advantage need to be filled to allow beneficiaries to make well-informed choices while also addressing disparities in health equity. It is also helpful to go through the policies of providers such as Astiva Health so that potential beneficiaries obtain clarity on what to expect when they sign up.
NOTE TO INVESTORS: The latest news and updates relating to Astiva Health are available in the company’s newsroom at https://ibn.fm/Astiva
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