More than 31 million seniors and people with disabilities choose Medicare Advantage (MA) because it delivers better services, better access to care, and better value. It has strong bipartisan support because it is a prime example of the government and free market working together to deliver lower costs, more choices, and better outcomes for the American people.
But what does better value, better care, and better quality really mean? How is it measured? Read below for some key analyses on how Medicare Advantage helps keep America鈥檚 seniors and people with disabilities healthy while providing real value in health care.
Achieving Better Health for Seniors
In a released in the April 2023 issue of Health Affairs, a team of independent researchers analyzed quality and utilization measures in Medicare Advantage and original Medicare, finding that:
- MA health maintenance organizations (HMO), the most common form of MA plan, outperformed original Medicare on 7 of 7 clinical quality measures, including various key preventive screenings and treatments, and monitoring of patients taking certain medications.
- MA HMOs outperformed original Medicare on 5 of 7 patient-reported quality measures in 2017, including key ratings of overall care, ability to get needed care, and ability to get care quickly.
- MA plan enrollees had fewer emergency department visits, outpatient visits, and inpatient admissions compared to original Medicare, providing further evidence that MA provides high-quality, coordinated, cost-effective care.
- MA plans鈥� superior performance occurred during a period of significant program growth (the proportion of Medicare beneficiaries enrolled in Medicare Advantage nearly doubled from 2010 to 2017).
Medicare Advantage Penetration is Related to a Reduction in Use of Post-Acute Care:
A separate released in the April 2023 issue of Health Affairs by a team of independent researchers analyzed the relationship between MA penetration in an area and use of post-acute care among original Medicare beneficiaries. The study鈥檚 key finding was 鈥渋ncreased Medicare Advantage (MA) market penetration associated with reduced post-acute care use among traditional Medicare beneficiaries, without a corresponding increase in hospital readmissions.鈥� In other words, in areas where more individuals choose MA, MA鈥檚 greater efficiency helps reduce utilization and costs for everyone with Medicare.
Additional findings from the study:
- Across the 3 diseases included in the study (congestive heart failure, hip fracture, and stroke), an increase in MA market penetration was associated with less use of any post-acute care among original Medicare beneficiaries.
- The association between higher MA penetration and lower post-acute care use in original Medicare was stronger in markets with a greater share of Medicare beneficiaries in accountable care organizations. This suggests that some of the lower spending attributed to accountable care organizations may in reality be the positive spillover of higher MA penetration in the service area.
To put these results into context, it is important to note the findings from the previously mentioned Health Affairs . MA plans outperform original Medicare on 7 of 7 clinical quality measures and 5 of 7 patient-reported quality measures. And plan enrollees have fewer emergency department visits, outpatient visits, and inpatient admissions compared to original Medicare. Simply put, MA helps more people get and stay healthy, and is leading the way in helping reduce the need for post-acute care and unnecessary spending across the Medicare program.
Medicare Advantage Makes Care More Affordable for More Americans:
As noted in the , the Part A (Hospital) Trust Fund is expected to become insolvent in 2031, three years later than the prior year鈥檚 projection. This demonstrates that lower spending is helping to extend the life of the trust fund.
A key highlight in the report is the increased enrollment in MA by dual eligible enrollees. Because more dual-eligibles are choosing Medicare Advantage for its affordability and value, Medicare Advantage has helped to decrease average per-capita costs in the original Medicare program, helping to improve the solvency of Medicare Part A.
Medicare Advantage delivers affordable coverage by reducing Medicare鈥檚 cost sharing and offering additional benefits that original Medicare doesn鈥檛 cover, such as integrated vision, hearing, and dental benefits, a cap on out-of-pocket costs, wellness programs, in-home caregiver support, and innovative telehealth options. This is tremendous value for every American senior and taxpayer, and health insurance providers are committed to strengthening and improving MA for the millions of Americans who depend on it for their health and financial well-being.