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Policy

Research

January 18, 2017

Millions of Medicare Advantage beneficiaries in 4 or 5-Star rated plans are negatively impacted by the benchmark cap and do not receive the full benefits of a high-quality plan.

In this Spotlight on Innovation case study, BMA highlights how Medicare Advantage facilitates care coordination at Iora Health, one of the innovative primary care practices in the country. The Iora Primary Care model for seniors over 65 years old is enabled by the value framework provided under Medicare Advantage.

Greater use of Medicare Advantage (MA) over traditional fee-for-service Medicare (TM) in certain populations, and even across small areas, has been associated with fewer overall hospitalizations and avoidable hospitalizations. We set out to update and advance previous analyses, using the most contemporary multistate hospitalization data and focusing on the impact MA penetration has on avoidable hospitalizations.

New data from the Medicare Current Beneficiary Survey (MCBS) show that Medicare Advantage plans, Medicare’s private comprehensive health plans, continued to be a vital source of coverage for lowincome beneficiaries and racial/ethnic populations in 2012.

by Jayasree Basu and Lee Rivers Mobley

The findings indicate that MA plans have added value to the quality of primary care for the elderly by reducing preventable hospitalizations.

Beneficiaries in Medicare HMOs were consistently more likely than those in traditional Medicare to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease.

by Joseph P. Newhouse and Thomas G. McGuire

On average, Medicare Advantage (MA) plans appear to offer higher value than Traditional Medicare (TM), and positive spillovers from MA into TM imply that reimbursement should not necessarily be neutral. 

Medicare Advantage beneficiaries are on average paying more for less as a result of federal payment rate cuts implemented each plan year from 2012-2015. Medicare Advantage enrollees who need the most care have seen their maximum annual out-of-pocket costs increase by up to $761 since 2012. While seniors and people with disabilities in 211 U.S. counties now have no access to Medicare Advantage general enrollment plans.