What to know when covering the booming Medicare Advantage market

By Jon Harris, New York Health Journalism Fellowship

The Medicare Advantage market is booming. It's lucrative for health insurers who aggressively market their plans to some of the nation's most vulnerable people.

And, in many ways, it's an underreported topic with no shortage of stories to tell, panelists said during a Health Journalism 2024 session about untangling the complex web that is Medicare Advantage.

Medicare Advantage plans are offered by private health insurance companies. The biggest players in this market are UnitedHealthcare and Humana - as an alternative to traditional Medicare, explained Tricia Neuman, senior vice president of KFF and executive director of its program on Medicare policy.

More than half of those eligible now get Medicare benefits through a private Medicare Advantage plan rather than traditional Medicare, she noted.

In terms of dollars, about 1.5% of the country's gross domestic product, or about 5% of the federal budget, goes to a Medicare Advantage plan, estimated Dr. Amal Trivedi, professor of health services, policy and practice at Brown University.

"It's just been stunning to witness what's happened in this program and watch Medicare Advantage take over the world, so to speak," he said.

Medicare Advantage plans do offer some extra perks to beneficiaries, such as dental and vision coverages, no supplemental premiums and an annual out-of-pocket limit - alluring to seniors on fixed incomes.

But there are major tradeoffs that many beneficiaries are not aware of when they enroll in a Medicare Advantage plan, including certain services subject to prior authorization and narrower provider networks.

It can be complicated for Medicare-eligible people, especially amid the blitz of Medicare Advantage ads always circulating. Neuman said KFF found that, during a nine-week advertising period, there were nearly 650,000 airings of Medicare ads, many featuring celebrity endorsements.

"Folks kind of brace themselves for watching TV during the month of October, which is the month for open enrollment, and it's just a bombardment of ads on Medicare Advantage," Trivedi said.

Also concerning, Trivedi noted, is the high turnover and churn in Medicare Advantage plans, particularly among high-need, high-cost patients.

He added there's still more that experts are trying to learn about Medicare Advantage, noting there is "unclear evidence about the value for taxpayers and whether beneficiaries have better welfare in terms of joining these plans."

Veteran journalist Cheryl Clark, a contributing writer for MedPage Today, provided story ideas that journalists can pursue.

She urged journalists to investigate the sneaky ways that Medicare Advantage plans recruit enrollees, referencing a story she did about how an insurer used a health system's patient portal to send messages to patients.

Clark also has told stories of patients who were stuck waiting for authorization from their Medicare Advantage plan for crucial health services - delays that don't happen as often on traditional Medicare.

"You can find stories in your own neighborhood," she said.

Jon Harris is a health care reporter at The Buffalo News and a 2024 AHCJ-New York Health Journalism fellow.