Enrollment in the Medicare Advantage program has more than doubled since 2011. At the end of last year, the program had 28 million participants, accounting for 45% of all Medicare beneficiaries.
Most of these enrollees are satisfied with their plan and prefer it to other forms of Medicare insurance like Medigap, according to a report released Monday by online health insurance broker eHealth. Enrollees cited Medicare Advantage’s affordability and comprehensiveness are their main reasons for satisfaction.
For its report, eHealth surveyed 2,848 Medicare Advantage enrollees in late May. Eighty-eight percent of enrollees expressed satisfaction with their plan, and 86% said they would recommend Medicare Advantage to family or friends.
Nearly half of Medicare Advantage enrollees said they chose the plan because they wanted all their Medicare benefits housed in a single plan, an option they can’t get if they are enrolled in a supplemental plan like Medigap.
Most of the respondents who were previously enrolled in Medigap preferred Medicare Advantage. Among this group, 59% of beneficiaries said they were more satisfied with their Medicare Advantage plan, and an additional 23% said they were equally satisfied.
These high satisfaction rates are good news because most Medicare Advantage enrollees reported that they would have trouble affording alternative plans. Two-thirds of respondents who selected Medicare Advantage over Medigap made the choice because Medigap was too expensive. If they had to look for similar coverage elsewhere, three-quarters of Medicare Advantage enrollees said they could not afford monthly premiums more than $50.
Just 6% of enrollees were dissatisfied with their plan. Among these respondents, complaints focused on doctor networks, out-of-pocket costs and prescription drug coverage.
Overall, 13 percent of respondents said they have had a claim or prior authorization request denied. Among this group, 43 percent said they were informed the service in question was excluded from coverage under their plan — many of these denials were for services like dental and vision care, which Medicare does not typically cover. Another 15 percent said the denial was because their service or prescription was deemed not medically necessary.
eHealth’s report comes three weeks after the American Hospital Association sent a letter to the Centers for Medicare & Medicaid Services to “take swift action to hold Medicare Advantage plans accountable for inappropriately and illegally restricting beneficiary access to medically necessary care.” The AHA’s letter was a response to a report from HHS’ Office of Inspector General that found an estimated 13% of Medicare Advantage’s prior authorization denials and 18% of its payment denials should have been granted.
Holding Medicare Advantage plans is important given that enrollment in such plans is set to outpace enrollment in traditional Medicare by 2025.
Photo: zimmytws, Getty Images
