As Medicare Advantage gains traction over traditional Medicare, there are several important potential issues that demand oversight, according to a paper published in The New England Journal of Medicine.
“The emerging role of Medicare Advantage, the private-plan alternative to traditional Medicare, is gradually changing the Medicare program in ways that have important implications for beneficiaries, providers and spending,” Patricia Neuman, ScD, and Gretchen A. Jacobson, PhD, both from Kaiser Family Foundation, wrote.
Enrollment in Medicare Advantage plans has increased threefold since 2005, and now includes approximately 20 million beneficiaries, according to Neuman and Jacobson. If enrollment continues to grow as expected, Medicare may change drastically in the future and function like a marketplace of private plans rather than a national insurance program, they wrote.
“This may or may not be the program that people envision when they talk about Medicare for All,” they wrote.
Generally, both Democratic and Republican policymakers support Medicare Advantage plans because their constituents favor them, according to Neuman and Jacobson. Medicare Advantage offers enrollees extra benefits, financial protection and a convenient “one-stop shop” for all coverage, which have attracted many seniors to enroll in the plan, they wrote. New health insurers are expanding into the Medicare Advantage market, indicating that it is one of the more lucrative health insurance products, they wrote.
However, these benefits to insurers and enrollees come “at a cost to taxpayers and may reemerge as an issue down the road, when federal spending becomes a more pressing policy concern,” according to Neuman and Jacobson.
Providing stronger financial protections and out-of-pocket limits for beneficiaries in Medicare Advantage vs. traditional Medicare may prove to be an equity issue as out-of-pocket spending rises, they wrote.
Neuman and Jacobson also noted concerns that Medicare Advantage varies widely across plans and lacks data for more vulnerable patients. An extremely high disenrollment rate among higher-need patients also warrants attention, they wrote.
“Still to be determined is how the growing role of private insurance in Medicare, and the diminishing role of traditional Medicare, is likely to affect beneficiaries’ out-of-pocket spending, satisfaction and health outcomes over time,” Neuman and Jacobson wrote. – by Alaina Tedesco
Disclosures: The authors report no relevant financial disclosures.