piggy bank and stethoscope

“The growing role of Medicare Advantage in the Medicare program and the changing demographics of Medicare Advantage enrollees have given rise to an interest in how well private plans serve their enrollees relative to traditional Medicare,” Nancy Ochieng and Jeannie Fuglesten Biniek write in a report for Kaiser Family Foundation. “To answer this question, we build on a previous review of research by examining 62 studies published since 2016 that compare Medicare Advantage and traditional Medicare based on measures of beneficiary experience, affordability, service utilization, and quality. We found few differences between Medicare Advantage and traditional Medicare that are supported by strong evidence or have been replicated across multiple studies. Both Medicare Advantage and traditional Medicare beneficiaries reported similar rates of satisfaction with their care and overall measures of care coordination. Medicare Advantage outperformed traditional Medicare on some measures, such as use of preventive services, having a usual source of care, and lower hospital readmission rates. However, traditional Medicare outperformed Medicare Advantage on other measures, such as receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies. Additionally, a somewhat smaller share of traditional Medicare beneficiaries than Medicare Advantage enrollees experienced a cost-related problem, mainly due to lower rates of cost-related problems among traditional Medicare beneficiaries with supplemental coverage.  … Findings related to the use of other health care services, including hospital care and prescription drugs, and condition-specific quality of care measures varied –- likely due to differences in data and methodology across studies. When possible, we highlight findings for specific subgroups of interest, such as beneficiaries from communities of color, living in rural areas, or dually eligible for Medicare and Medicaid. Notably, relatively few studies specifically examine these population subgroups, so it is difficult to assess the strength of the findings or how broadly they apply. For example, one study found that Black Medicare beneficiaries had higher rates of potentially avoidable hospitalizations in Medicare Advantage than in traditional Medicare. While important, we could not identify additional analyses that compared the rate of potentially avoidable hospitalizations between Medicare Advantage and traditional Medicare among Hispanic and other beneficiaries of color, beneficiaries living in rural areas, or beneficiaries dually eligible for Medicare and Medicaid.  … Our findings across all measures are summarized below.  … Beneficiaries in Medicare Advantage and traditional Medicare reported similar rates of satisfaction with their care, and similar experiences with wait times, finding a new provider, and overall measures of care coordination. However, Medicare Advantage enrollees were more likely to report having a usual source of care, receiving information during care transitions, and having better experiences getting needed prescription drugs. Switching: Overall, there were low rates of switching between Medicare Advantage and traditional Medicare, though a slightly larger share of Medicare Advantage enrollees opted to switch from Medicare Advantage to traditional Medicare than beneficiaries who switched from traditional Medicare to Medicare Advantage.” Nancy Ochieng and Jeannie Fuglesten Biniek, “Beneficiary experience, affordability, utilization, and quality in Medicare Advantage and traditional Medicare: A review of the literature,” Kaiser Family Foundation.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...