Medicare Advantage Trumps Medicare in 2023

Medicare Advantage (MA) is the preferred choice for over 32 million seniors and individuals with disabilities, due to its top-notch service, improved access to care and affordability.

A recent study conducted by AHIP revealed that MA plans have been proven to provide better access to preventive healthcare, helping to reduce disease risk and detecting illnesses at an early stage.

Over the last two decades, there has been a consistent increase in MA enrollment, driven by policy changes aimed at promoting a strong role of private plan choices in Medicare.

AHIP researchers analyzed the quality of care, service utilization, and medication patterns in both MA and Medicare plans, aiming to gain a deeper understanding of their impact on patients.

To do so, performance results were compared for certain Healthcare Effectiveness Data and Information (HEDIS) measures focused on preventive and chronic disease care in original Medicare and Medicare Advantage in 2019.

This study used Centers for Medicare & Medicaid Services (CMS) datasets spanning from 2016 to 2019 containing medical and pharmacy claims data from a 5% sample of Medicare enrollees, including original Medicare and Medicare Advantage enrollees.

The study included enrollees who were continuously enrolled in either original Medicare (Part A and B) or Medicare Advantage (Part C) and were enrolled in drug benefit coverage (Part D) between January 1, 2018 and December 31, 2019. For select measures, enrollees had to be continuously enrolled for 4 years from January 1, 2016 to December 31, 2019.

The study used the 2019 Healthcare Effectiveness Data and Information Set (HEDIS) to develop measures for proactive healthcare quality. Across 11 measures, Medicare Advantage outperformed original Medicare in all but one — cancer screenings.

Overall, a higher share of Medicare Advantage enrollees were screened for 2 common forms of cancer than those with original Medicare.

Data revealed that in comparison to original Medicare, Medicare Advantage displayed better healthcare outcomes across various measures including:

A higher percentage of Medicare Advantage beneficiaries participated in screenings for breast cancer (73.3% vs. 69.9%) and colorectal cancer (38.9% vs. 33.1%).

In cases of cardiovascular disease, Medicare Advantage enrollees demonstrated higher rates of completing beta-blocker courses (81.8% vs 80.7%) after a heart attack and adhering to statin therapy.

Similarly, individuals with diabetes under Medicare Advantage exhibited greater adherence to HbA1c testing and statin therapy (83.4% vs 80.4%).

Medicare Advantage also outperformed in providing disease-modifying antirheumatic drugs for rheumatoid arthritis, managing osteoporosis post-fracture, and controlling asthma in those under 65.

A greater proportion of Medicare Advantage members with chronic obstructive pulmonary disease (COPD) were given systemic corticosteroids (73.3% vs. 70.8%) and bronchodilators (65.5% vs. 64.8%). The variance in bronchodilator usage wasn't statistically significant.

However, newly diagnosed COPD patients among Medicare Advantage enrollees had fewer spirometry tests confirming diagnosis (41.5% vs. 44.7%), but the difference lacked statistical significance.

Additionally, a KFF Analysis published in August 2023 revealed these MA trends that were found for 2023:

• In 2023, nearly two-thirds of Medicare Advantage enrollees are in individual plans that are open for general enrollment.
• Roughly 5.4 million MA enrollees are in a group plan offered to retirees by an employer or union.
• More than 5.7 million Medicare beneficiaries are enrolled in special needs plans in 2023, double the enrollment in 2018.
• UnitedHealthcare and Humana have consistently accounted for a relatively large share of MA enrollment.