Friday, October 26, 2018

It is expected that more and more older adults and those eligible for Medicare will review their health care options and choose Medicare Advantage during the 2019 Medicare Open Enrollment Period. For policymakers, it is a good time to consider why this is happening. 

Part of the answer is due to the amazing transformation in health care delivery being led by Medicare Advantage, the private-public option in Medicare that offers older adults health care options that are flexible and innovative. 

Imagine a health care delivery system that uses meaningful data to identify high need individuals and seeks them out for care, which provides smart benefits flexible enough to address social determinants and aligns strategic goals between payors, providers, and government to increase cost efficiencies and achieve better outcomes for the patient. That is what Medicare Advantage is doing, as plans and providers work together to implement new ways to meet the needs of complex patients that offers choices, improves care, and drives down out of pocket costs.

Recent data released by Centers for Medicare and Medicaid (CMS) shows that almost 270 Medicare Advantage plans will offer new and expanded health-related supplemental benefits in 2019. These additional benefits may include adult day care services and in-home support services, caregiver support services, as well as reduced cost-sharing and additional benefits for beneficiaries with certain conditions, such as diabetes and congestive heart failure.

For the second year in a row, Medicare Advantage is driving down out of pocket costs.  The average Medicare Advantage monthly premium will decrease 6.5% in 2019, from $29.81 in 2018 to $28.00 in 2019.  CMS estimates that 83% of Medicare Advantage enrollees will have the same or lower premium in 2019 if they continue in their same plan, and 26% of enrollees will see premium decreases. Approximately 46% of enrollees will have access to a zero-premium plan in 2019.  This is good news for enrollees.

CMS also estimates that access to Medicare Advantage plans, many of which also include Part D coverage, will be almost universal, with 99% of Medicare beneficiaries having access to at least one health plan in their area. The total number of plan choices will increase from 3,100 in 2018 to about 3,700 in 2019, and more than 91% of beneficiaries will have access to 10 or more plan options in 2019 (compared to 86% in 2018).

With the ability of Medicare Advantage plans to design modern benefit packages for beneficiaries, lower out of pockets costs and offer great access to plan options, it is no wonder that older adults are choosing to receive their health care through Medicare Advantage. CMS estimates that 22.6 million Medicare beneficiaries will enroll in Medicare Advantage in 2019, representing 36.7% of the Medicare population. This represents an 11.5% increase from 2018, which is the largest annual increase in recent years.

What has been critical to encouraging this transformation in Medicare has been the support from Congress and the Administration. CMS is providing Medicare Advantage plans with new flexibilities in benefit design, as well as possible expanded health-related supplemental benefits.   This is offering new opportunities for innovative care delivery for all beneficiaries and the means to address critical health concerns for those with serious chronic conditions.

Regulatory action that has offered stability and legislative actions, such as the passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act and delaying Health Insurance Tax (HIT), have been critical to creating the environment that has resulted in greater integrated care, expanded benefits and lower out of pocket costs.  All to the benefit of Medicare beneficiaries.

The bipartisan support for Medicare Advantage by the Congress and CMS has enabled the advancement of innovative care delivery now proven to be the health care critical to today’s older Americans.

Allyson Y. Schwartz is a former Congresswoman and current President & CEO of Better Medicare Alliance

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