RISE rounds up the latest news involving Medicare Advantage (MA) plans.
7 findings from Avalere analysis on 2022 MA plan offerings
More MA plans will offer non-medical supplemental benefits in 2022, according to a new analysis from Avalere. Those benefits include meals (pre-made meals that may be delivered to a patient’s home), transportation, nutrition (general education and nutrition counseling from a practitioner), and in-home support services.
The analysis compared 2021 and 2022 plan offerings and premiums, as well as changes in benefits offerings by the plan’s Star rating. The report found:
- The most commonly offered non-medical supplemental benefit in 2022 will be meals (68 percent), followed by transportation (39 percent), nutrition (30 percent), and in-home support services (11 percent)
- More plans will offer meals, nutrition, transportation, or in-home support services at a $0 premium in 2022
- The percentage of all plans that offer meals as a supplemental benefit at a $0 premium will increase from 30 percent in 2021 to 40 percent in 2022
- In 2022, the percentage of all plans offering nutrition at a $0 premium will more than double from 2021 (9 percent to 19 percent)
- Nearly all beneficiaries will have access to at least one $0 premium plan offering meals as a supplemental benefit in 2022
- In 2022, plans with at least 4 Stars are more likely to offer meals (70 percent vs. 62 percent) or transportation (40 percent vs. 32 percent)
- However, 4-Star plans in 2022 are less likely to offer nutrition (26 percent vs. 36 percent)
Milliman study: MA delivers $32.5B annually in additional value to seniors through lower cost-sharing, extra benefits
Better Medicare Alliance on Thursday announced the release of a new report commissioned by its 501(c)3 research arm, the Center for Innovation in Medicare Advantage, and conducted by Milliman highlighting the value of MA to the federal government.
The report found that “the [federal] government’s dollar goes farther with MA plans providing Medicare-covered benefits at least as generous as FFS for less than what the same benefits cost under FFS Medicare.”
Indeed, MA provides $32.5 billion annually ($123.36 per member per month) in additional benefits and lower out-of-pocket costs for beneficiaries, according to the analysis. Specifically, data show that MA plans cover the same hospital and physician services at 24 percent lower cost per member per month than FFS Medicare ($709.66 in MA vs. $935.67 in FFS), excluding administrative expense and profits.
Milliman additionally finds that, when including these considerations, “total FFS payments [per month are] slightly higher than total MA payments ($949.39 vs. $942.43) for beneficiaries of a similar health status.”
In reaching these figures, Milliman researchers applied a sensitivity analysis by adjusting FFS Medicare costs by +/-5 percent to account for the possibility that government payments to MA and FFS Medicare are not directly comparable. The sensitivity analysis shows that “even with 5 percent lower FFS Medicare costs for Medicare-covered services, MA is still less expensive in total program costs than FFS.”
AHA urges CMS to address prior authorization issues affecting MA patients
In an Oct. 18 letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) urged the agency to revise and reissue recent proposed streamlining prior authorization to ensure benefits extend to patients enrolled in MA plans; consider additional regulations to limit care delays; and conduct oversight and enforcement for plans who have demonstrated problematic prior authorization usage in the past.
CMS recently took action to streamline prior authorization through a notice of proposed rulemaking released in December 2020. If finalized, the regulation would create a standardized method to identify whether a procedure was subject to prior authorization, submit prior authorization and supporting documentation, and receive a determination from the health plan. Additionally, the regulation recognized the need to reduce the amount of time that prior authorizations take to process.
The proposed rule would place new requirements on Medicaid and Children's Health Insurance Program (CHIP) managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs). CMS also indicated that Medicare fee-for-service will be adhering to the requirements.
“The notable exclusion of MAOs is extremely troubling and significantly reduces the potential impact of the regulation,” wrote Stacey Hughes, executive vice president, government relations and public policy for the AHA.
Approximately one-third of all Medicare beneficiaries (approximately 22 million people) are enrolled in an MA plan, she said in the letter, adding that the Congressional Budget Office projects this percentage to increase to approximately 47 percent by 2029.
“In order to promote procedural improvements and prevent negative health outcomes associated with delays in care for all beneficiaries, we urge CMS to require MAOs to adhere to the requirements set forth in this proposal. Including them also would reduce administrative burdens and costs as providers would have less variation among health plans,” she wrote.