AffordableCare, Capitation, Competition, Managed Care, MedicareAdvantage

Wilensky recommends autoenrolling seniors in MA Plans

An article co-authored by Gail Wilensky contains the following:

Congress should couple auto-enrollment with default assignment of new Medicare beneficiaries into the growing Medicare Advantage market as a promising first step for potentially being able to stabilize the future of Medicare and for providing more integrated care for America’s current and future seniors.” 

https://www.heritage.org/health-care-reform/report/the-next-step-medicare-reform

The article makes these factual points in favor of MA plans

  • In 2019, the average premium of MA plans (paid for as a separate cost to those of Part A and B) is estimated to be 7.2 percent ($4.50) cheaper than the basic Part D premium alone (which traditional Medicare beneficiaries purchase separately).[1] 
  • Further, in 2019, half of MA beneficiaries had a “zero premium” plan,[2]  and average premiums are expected to decrease by 23 percent in 2020[3]
  • MA plans also set limits on out-of-pocket costs to consumers, unlike its FFS alternative.
    • For HMOs that cover in-network services, this limit averaged $5,059 for 2019 and could not exceed $6,700.
    • PPOs, which offer coverage for both in-network and out-of-network providers, must have a combined limit on out-of-pocket costs of $10,000 or less, though this averaged $8,818 in 2019.[4]
  • With 41 percent of MA spending directed through risk-transfer payment models, MA exceeds other plan markets in transferring risk to providers.

[1] News release, “Medicare Advantage Premiums Continue to Decline While Plan Choices and Benefits Increase in 2019,” CMS, September 28, 2018, https://www.cms.gov/newsroom/press-releases/medicare-advantage-premiums-continue-decline-while-plan-choices-and-benefits-increase-2019 (accessed September 9, 2020).

[2] G. Jacobson et al., “A Dozen Facts About Medicare Advantage in 2019,” Kaiser Family Foundation, June 6, 2019.

[3] News release, “Trump Administration Drives Down Medicare Advantage and Part D Premiums for Seniors,” CMS, September 24, 2019, https://www.cms.gov/newsroom/press-releases/trump-administration-drives-down-medicare-advantage-and-part-d-premiums-seniors (accessed September 9, 2020).

[4] Ibid.,