Enrollment for Medicare Advantage Differs Sharply in California Counties

In America, Medicare Advantage is increasing in popularity among beneficiaries of Medicare. Insurers under this version of Medicare offer lower premiums, with dental and vision coverage added on.

Jointly, more than 50% of eligible recipients of Medicare are on private plans. However, a recent report from KFF determined that there were huge differences between enrollment in Medicare Advantage in the northern and southern counties of California. Data from the Centers for Medicare & Medicaid Services shows that market penetration for Medicare Advantage was considerably lower in northern counties in comparison to southern counties.

The state of California differs from other states such as Florida, which recorded consistent percentages of residents eligible for Medicare on private plans.

One financial literacy instructor at the University of Tennessee, Alex Beene, explained that the northern region of California had trailed behind other states in encouraging its residents to present all documentation required to register for these programs before the deadline lapsed. Beene added that Medicare Advantage also had an issue with advertising to individuals who weren’t enrolled in their program.

The KFF report also found that over one-third of beneficiaries of Medicare lived in a county where roughly 60% of all beneficiaries were enrolled in Advantage plans.

On a wide scale, Medicare Advantage is more popular, with the report highlighting that the variation in rates of enrollment at the county level reflects factors such as urbanicity of the county, rates of payment under Medicare, differences in company strategy, healthcare use patterns, number of Medicare beneficiaries and market penetration of Medicare Advantage.

In 30 states, beneficiaries under Medicare Advantage made up more than 50% of all enrollees. Additionally, 7 states had at least 60% of their recipients on privatized plans under Medicare.

Counties with lower rates of enrollment are in the rural areas while those in urban areas have more individuals enrolled under Medicare Advantage. This may be because of fewer healthcare providers that accept some plans under Medicare Advantage.

Other disadvantages of enrolling in a Medicare Advantage plan are that most insurers require hospitals and doctors to obtain approval for treatments in prior authorization requests, which can take anywhere between a couple of weeks to a few months. While Medicare Advantage claims that prior authorizations reduce unnecessary medical services and manage costs, these authorizations are seen by many patients and medical providers as a needless barrier to care.

The KFF report determined that between 2021 and 2022, prior authorization requests denied by Medicare Advantage rose to 7.4% from 5.8%. In total, 3.4 million requests were denied.

Companies such as Astiva Health offering Medicare Advantage coverage in California have plenty to do to bring on board all those who are still outside the system so that these individuals can also benefit from value-added services.

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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