September 30, 2024

BY Nicole Fallon

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Two reports-one from the Better Medicare Alliance, the other from CMS-offer insights into Medicare Advantage and Fee For Service uptake

As Medicare Open Enrollment begins October 15, two new reports provide encouraging news for Medicare beneficiaries considering signing up for a Medicare Advantage (MA) or Part D Prescription Drug (PDP) plan.

The Better Medicare Alliance (BMA), an MA advocacy organization, recently released its annual State of Medicare Advantage (MA) report, which discusses MA program trends, current demographics and an overview of plans' offerings. In addition, the Centers for Medicare and Medicaid Services (CMS) shared its fact sheet previewing what beneficiaries might expect from MA and Part D plan offerings for the 2025 benefit year.

Combined, these two sources suggest that MA plan enrollment can be expected to climb in the coming year by roughly two million more beneficiaries. Conversely, that projected growth is likely discouraging news for providers who face increased administrative burden and costs and lower reimbursement from these plans.

The BMA report also notes that the MA demographics show that MA is being selected by a more diverse and lower-income MA population than traditional Medicare. With capped out-of-pocket costs, low premiums and desirable supplemental benefits like hearing, vision, and dental, it is no surprise these populations are flocking to MA to stretch limited income.

The BMA reported positive outcomes for those enrolled in MA, including stronger access to primary care and lower inpatient utilization and emergency room use. In addition, the BMA report says that 95% of MA beneficiaries report being satisfied with their health care quality.

CMS provides additional good news for cost-conscious beneficiaries in its fact sheet that 2025 MA and Part D offerings will continue to have low- or no- cost premiums, with out-of-pocket costs and supplemental benefit offerings remaining relatively unchanged.

Nonetheless, providers can play a critical role as a trusted resource as Medicare beneficiaries weigh their options between selecting an MA plan and remaining in traditional Medicare with a PDP. Providers should share information with those they serve across their sites of service about which MA plans they contract with and which ones they don't, and their experiences working with these plans related to beneficiary access to services.