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Dive Brief:

  • Medicare Advantage remains extremely popular with beneficiaries, even as the plans’ private administrators face increased scrutiny from the government, according to a new survey from eHealth, a Medicare insurance plan broker.
  • Almost nine in 10 (88%) MA enrollees indicated they were satisfied with their coverage, and nearly two-Thirds (63%) said they were very satisfied. Just 6% were dissatisfied with their plans. “Medicare Advantage enrollees are overwhelmingly happy with their coverage,” the eHealth report said.
  • Yet the survey also found that 13% of those in an MA plan had a claim or pre-authorization request denied. The now commonly cited reasons for denials were plan exclusions and lack of medical necessity.

Dive Insight:

Medicare Advantage plans have doubled their enrollment since 2011 and now cover more than 29 million Americans, according to data from the CMS. Enrollees like the plans because they cover their preferred Doctors, Hospitals and Pharmacies (51%), have affordable premiums (49%) and cover prescription drugs at an affordable price (49%), eHealth’s research showed.

Nearly half (46%) received their chose Medicare Advantage because they wanted all of their Medicare benefits contained in a single plan.

As the program has soared in Popularity, however, it has attracted the attention of federal Investigators. The HHS ‘Office of the Inspector General released a report in April that found MA organizations wrongly denied members care, turning down 13% of prior authorization requests that would have been approved under traditional Medicare. The plans also denied 18% of payment requests that should have been approved.

The OIG report urged the CMS to update its audit Protocols and issue new guidance on medical necessity reviews performed by the plans.

Medicare Advantage is also attracting attention from researchers who warn the program is a key driver of Medicare’s overall fiscal woes. Enrollment in MA plans is projected to continue growing to cover half of all Medicare beneficiaries by 2026.

The eHealth survey of beneficiaries delved into the reasons MA participants faced a claim and pre-authorization denials, finding 43% were told the request was excluded from their plan, and 15% were declined because the service or supply was considered not medically necessary.

Many denials were for services such as dental and vision care that are typically not covered by Medicare, while 3% were for a specific prescription drug and 2% were for visits with certain Doctors. Less than 1% were denied coverage for inpatient hospital care.

The online private insurance broker polled more than 2,800 Medicare Advantage enrollees in late May for its report. Among the findings, the survey revealed that 67% of beneficiaries who chose MA plans did so because they couldn’t afford alternatives such as Medigap coverage, and 73% said they could afford no more than a $ 50 monthly premium.

Only 6% of MA enrollees were dissatisfied with their plans. Of that group, 29% cited lack of coverage for their preferred Doctors, Hospitals or Pharmacies, 25% blamed out-of-pocket costs and 22% pointed to prescription drug coverage.

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