A new analysis commissioned by AHIP and conducted by Wakely Consulting Group compares the value of Medicare Advantage (MA) with fee-for-service (FFS) Medicare.
The study shows that Medicare costs would rise nearly 10 percent if traditional Medicare beneficiaries had to enroll in both Part A and Part B and if FFS Medicare had to provide a maximum out-of-pocket (MOOP) limit, which are required under MA, according to the report.
Wakely analyzed 2023 costs and membership data from 100 percent claims and enrollment files, focusing on members enrolled in both Parts A and B. The consulting group has conducted similar studies before to ensure an “apples-to-apples” comparison of FFS and MA costs.
In the study announcement, AHIP said that accurate comparisons show MA manages costs more effectively and efficiently than FFS Medicare. “That’s why AHIP supports proposals, like the Apples-to-Apples Comparison Act, which would guarantee the use of accurate data and methodology in the government’s comparisons of the MA and FFS programs,” AHIP said.
The report found:
- Adding a MOOP provision to the traditional FFS program and matching the mandatory amount under MA would increase CMS’ net liability by 3.5 percent nationally. Wakely estimates that FFS costs for beneficiaries with end-stage renal disease (ESRD) would rise by 7.6 percent with an $8,300 MOOP in place.
- Costs for Medicare FFS beneficiaries without ESRD who are enrolled in both Parts A and B are about six percent higher than the total non-ESRD FFS population. If CMS used these costs to calculate Part C benchmarks, most county-level Part C benchmark rates would increase by a similar percentage.
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