Amid the sometimes gloomy landscape of US health insurance coverage — which 71% of Americans rate as fair or poor — there may be a silver lining: Medicare Advantage.
A new study, published today by eHealth (NASDAQ: EHTH), shows that people enrolled in Medicare Advantage plans are very satisfied with what they have.
Among people who purchased a Medicare Advantage plan through the eHealth website, 88% were very or somewhat satisfied with their coverage and only 6% were dissatisfied. Almost the same percentage (86%) said they would recommend Medicare Advantage to a friend or family member; only 3% said they would not.
Medicare Advantage, also known as Medicare Part C, combines Original Medicare – Parts A and B which cover inpatient and outpatient care – with other benefits, often including Part D prescription coverage and extras such as dental care, vision, hearing and fitness.
Nearly half (46%) of survey respondents chose Medicare Advantage because they wanted all of their Medicare benefits in one plan.
Of those who had previously enrolled in other types of Medicare coverage, 61% said they preferred Medicare Advantage and 24% said they were just as satisfied with Medicare Advantage as they had been with other Medicare coverage.
Specifically, 59% of respondents who purchased Medicare supplement plans, also known as Medigap, were more satisfied with their Medicare Advantage plan. Two-thirds (67%) of those who said Medigap was too expensive. A quarter said they preferred Medicare Advantage because Medigap does not offer drug coverage.
Other reasons respondents chose to enroll in Medicare Advantage include coverage from preferred doctors, hospitals, and pharmacies; prescription drug coverage; and affordable monthly premiums.
Yet some of the same motivations for enrolling in Medicare Advantage were also the top reasons cited among the minority of respondents who said they were dissatisfied with Medicare Advantage. For example, 29% of dissatisfied respondents attributed their dissatisfaction to the lack of coverage from their favorite doctors, hospitals or pharmacies. Another 22% pointed to the lack of prescription drug coverage.
The survey also revealed a high degree of price sensitivity among respondents. Almost half (48%) said they couldn’t afford monthly premiums and 25% said they could only afford monthly premiums under $50. Three-quarters (74%) said they could only afford annual outlays of $1,000 or less.
These results may help explain the growing popularity of Medicare Advantage plans.
In 2021, 26 million people, or 42% of all Medicare beneficiaries, chose Medicare Advantage. Medicare Advantage enrollments have more than doubled in the past ten years.
According to the Kaiser Family Foundation, most (59%) Medicare Advantage plans with prescription drug coverage on the market in 2022 charged no additional monthly premium (beyond the standard Medicare Part B premium from Original Medicare). Almost all (98%) Medicare beneficiaries had access to at least one zero-premium Medicare Advantage option that included prescription drug coverage.
These are popular options. Nearly two-thirds (65%) of registrants chose premium-free plans. Another 20% pay less than $50 per month for their Medicare Advantage plan with prescription drug coverage.
Medicare Advantage’s picture is not quite rosy, however.
A federal report released in April 2022 suggested that Medicare Advantage plans could delay or deny medically necessary care. A review of denied claims showed that 13% met Medicare coverage criteria, suggesting that Medicare Advantage plans applied additional criteria not found in Medicare rules. In addition, the review revealed that some requests for additional documents were not necessary. These results suggest that Medicare Advantage plans created an excessive burden on patients to receive needed care.
The latest report was consistent with a 2018 review that showed high levels of successful calls. Of the denied claims that beneficiaries attempted to appeal, 75% of the denials were reversed, indicating that they may have been improperly denied in the first place.
In the eHealth survey, respondents reported relatively few denials of coverage. Overall, 13% saw their complaint or their request for prior authorization refused. Far fewer had been denied coverage for a specific prescription (3%), visits to a specific doctor (2%) or coverage for hospitalization (1%).
Of those who received a denial, 43% said the reason was because the requested service was excluded from their coverage and 15% said the denial was because their request was not deemed medically necessary. Ultimately, 15% said the initial denial was eventually reversed and paid for by their insurer.
Overall, eHealth results are a good reflection of the Medicare Advantage option. Most (61%) of survey respondents said they viewed Medicare Advantage as a good example of public/private cooperation.