We have mentioned in our previous blogs how Covid-19 reshaped the landscape of the healthcare industry. In this article, we will take a closer look at how the Medicare Advantage (MA) enrollment continues to surge as a likely result of the same phenomenon caused by the pandemic.
Current trend in Medicare Advantage Enrollment
We are seeing a continuous uphill trend in MA enrollment over Traditional Medicare (TM) as of this writing. According to the brief released by the Kaiser Family Foundation (KFF), 48% eligible beneficiaries enrolled in an MA plan as of June 2022; that is 28.4 million out of the 58.6 million overall Medicare beneficiaries. KFF also reported that Medicare-eligible beneficiaries have doubled from 2007 to 2022, 19% to 48% successively. Out of this emerging growth, 2.2 million beneficiaries were added between 2021 to 2022. Using KFF’s calculation, the Congressional Budget Office (CBO) made a projection of MA enrollments to a growth of 61% by 2032. You may access more details of the KFF brief on their website.
Reasons for the MA Surge
Medicare Advantage has an upper hand over Traditional Medicare for its ability to retain members; one reason could be the plan flexibility that MA offers. A study made by JAMA Health Forum showed that 77% of TM beneficiaries switched to MA and stayed in the plan even after five years.
Members who switched from TM have either a disability or chronic condition that is also eligible for Medicaid. They are the members that need comprehensive coverage in their plans. In comparison, TM coverage is limited compared to what MA plans offer.
Additional benefits are available with Medicare Advantage, including dental care and vision coverage, which are unavailable with Traditional Medicare.
Medicare Advantage also offers supplemental benefits for members with chronic illnesses requiring an out-of-pocket expense, which MA made considerably lower in cost. The limit set by the Centers for Medicare & Medicaid Services for out-of-pocket coverage for hospital and medical utilization is $8,300 in 2023.
Lower premium cost
In addition to the additional coverage and supplemental benefits, MA also offers a significantly lower premium which became very appealing for both old and new members.
Quick Summary about Medicare Advantage
What is Medicare Advantage
Medicare Advantage, also known as Medicare Part C is a bundled alternative to Traditional Medicare offered by private insurers. MA plans include Medicare Part A for hospitalization, Medicare Part B for outpatient doctor’s visits, and Medicare Part D for drug prescription coverage. Some plans offer coverage for routine dental and eye care. And in special cases, approvals may be given too for eyeglasses and hearing aids.
Traditional Medicare versus Medicare Advantage
Provider network is one of the differences between TM and MA. The former has extensive provider options with doctors to medical facilities that accept Medicare, while the latter has limited network choices. Provider options is one of the disadvantages of MA that members need to consider because it may result in more cost for beneficiaries.
Another difference is the premium; although MA has less freedom in terms of providers, one of the best advantages is its cost-efficiency than Traditional Medicare. One, because there is a cap for the maximum out-of-pocket limit for covered care set at $8,300 for 2023. And two, there are cases where the Medicare Advantage plan may have a $0 premium.
These are the most common types of Medicare Advantage plans:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-For-Service (PFFS)
- Special Needs Plans (SNPs)
- Provider Sponsored Organizations (PSOs)
- Medical Savings Accounts (MSAs)
The surge in Medicare Advantage enrollment has many moving parts; for the beneficiary members, healthcare providers, companies and the government. Key to making the utilization a success for the entire ecosystem requires access to and efficient and accurate documentation. It also needs protection for the members and for them to get full coverage of their plans and gain access to their medical records without undermining the preservation of patient confidentiality.
On the other side of the spectrum, providers should have full access to medical records from all channels of care, so that treatment and management can be done urgently without compromising accuracy. The healthcare team needs full support by maximizing the benefits of modern technology from IT experts. Currently, the biggest hurdle for the healthcare team is documenting and proper HCC coding. This hurdle is critical in making HCC coding and risk adjustment documentation have a positive outcome.
The good news is there are tools that providers can use; from physicians, nurses, rehab specialists, radiology technicians, medical technologists – practically by everyone on the team to make sure that their documentation and coding is updated accurately and in real-time. One of these available tools is a software created by Inferscience called the HCC Assistant. Their system can be used seamlessly across major environments and can be the key player for physician groups that have Medicare Advantage contracts. To get a call for a demo, click this link https://www.inferscience.com/hcc-assistant-real-time-hcc-coding-guidance-2-2.