Medicare Advantage Plans Provide No Substantial Cost Savings Over Traditional Medicare

[Duaine]

Medicare Advantage (MA) plans do not necessarily lead to cost savings for beneficiaries, especially those who are from vulnerable populations, according to a new study published in Annals of Internal Medicine.

While one report found patients with type 2 diabetes had better outcomes when they were enrolled in MA compared with patients in traditional Medicare, another analysis found patients with cancer in MA are more likely to be admitted in hospitals with physicians who have less experience performing complicated surgeries compared with traditional Medicare enrollees, and the MA enrollees are more likely to die within 30 days after the removal of their liver, pancreas, or stomach.9 Additional research found patients on MA received shorter and less intensive home health care compared with patients on traditional Medicare even if they had similar needs.

[EXTERNAL LINK] - Medicare Advantage Plans Provide No Substantial Cost Savings Over Traditional Medicare

 

[somarco]

The touted MA "savings" disappears quickly with certain health conditions . . . chronic or life threatening

 

[sshafran]

The touted MA "savings" disappears quickly with certain health conditions . . . chronic or life threatening

I don't disagree.

But today I had a 72 yr old retiring. Her G will be $135. Her PDP is $46 w/ $545 deductible then 15% coinsurance on her 2 expensive Rxs.

Vs $0 MA w/ $3,600 MOOP and better Rx coverage by a long shot.

$181/mo premium swing, no deductible on Rx's and $45 copay on her Tier 3's (vs 15%)

Most people would jump at the MA option.

She's leaning towards Plan G. For several reasons: (a) Simplicity - she can afford the premium and has worked until 72 (IRMAA bracket) and wants to worry about other stuff. (b) Concern over the SNF - she dealt with it with her mom (her mom had a supp so got 100 full days).

Some clients can see beyond the immediate dollars and cents - thankfully. Though she's still going to consider the MA option, just to be thorough.

If the PDPs weren't horrible (comparatively) it would be easier for a lot of people to stay out of MA.

 

[Fisher]

If the PDPs weren't horrible (comparatively) it would be easier for a lot of people to stay out of MA.

Such an often overlooked yet vitally important point.

 

[somarco]

In 2024 the beneficiary Part D OOP is capped at $3300 for formulary drugs

In 2025 the PDP OOP will be capped at $2000.

What is the max OOP for Part D under MAPD?

 

[Chazm]

The same. And MAPD drug coverage will still be better than a PDP plan.

 

[somarco]

@Chazm thx for confirming my suspicion . . . the OOP max applies to the D in MAPD.

 

[somarco]

And this is also true?


The out-of-pocket costs that help you reach your MOOP include all cost-sharing (deductibles, coinsurance, and copayments) for Part A and Part B covered services that you receive from in-network providers. Part D cost-sharing does not count towards your plan’s MOOP.

Maximum out-of-pocket limit - Medicare Interactive

All Medicare Advantage Plans must set an annual limit on your out-of-pocket costs, known as the maximum out-of-pocket (MOOP). This limit is high but […]

www.medicareinteractive.org

 

[Dutch]

And this is also true?


The out-of-pocket costs that help you reach your MOOP include all cost-sharing (deductibles, coinsurance, and copayments) for Part A and Part B covered services that you receive from in-network providers. Part D cost-sharing does not count towards your plan’s MOOP.

Maximum out-of-pocket limit - Medicare Interactive

All Medicare Advantage Plans must set an annual limit on your out-of-pocket costs, known as the maximum out-of-pocket (MOOP). This limit is high but […]

www.medicareinteractive.org

true.

 

[Fisher]

And this is also true?


Part D cost-sharing does not count towards your plan’s MOOP.

Always has been.