Low Satisfaction With Access To Care, Rural People On Medicare Advantage Switch To Traditional Medicare | Now


More than one in 10 seniors (10.5%) enrolled in a Medicare Advantage plan, also known as a Medicare managed care option, and living in a rural area, have switched to the traditional plan. Medicare during 2010-2016. The change was mainly due to low satisfaction with access to care, according to a study published this week in Health affairs researchers from Dornsife School of Public Health at Drexel University. In contrast, only 1.7% of traditional rural Medicare enrollees switched to Medicare Advantage during this period.

The results, among the first to examine rates of switching between the two options among rural and non-rural registrants, found a similar, but more muted, effect among non-rural registrants, with 2.2% of traditional Medicare registrants. and 5% of those enrolled in Medicare Advantage. the switch.

The change was most common among Medicare Advantage enrollees who experienced higher costs, such as hospitalization or long-term stay in a facility. Among those requiring more expensive services, rural enrollees were about twice as likely to switch from Medicare Advantage to traditional Medicare as non-rural enrollees (16.8% vs. 8.3%), suggesting that the limited options of providers in rural areas have been a major factor prompting consumers to change their coverage plan.

“We looked at 11 factors that might make someone change health insurance and found that much of this shift from Medicare Advantage to traditional Medicare among rural residents came from the limited availability of providers. However, the quality of care or reimbursable costs played a limited role. »Says the main author Sungchul Park, PhD, assistant professor at the Dornsife School of Public Health. “It’s not that rural patients were sicker than non-rural patients, they might just have a lot more trouble than their counterparts when it comes to finding an approved medical provider.”

Unlike traditional Medicare, which is administered by the Centers for Medicare and Medicaid Services, Medicare Advantage is administered by private companies approved by the government. Traditional Medicare and Medicare Advantage both include hospital (Part A) and medical (Part B) insurance. However, the funding for the two programs differs and influences the way they are delivered. In traditional health insurance, the federal government pays for the services provided, but the government pays Medicare Advantage insurers using fixed, pre-negotiated rates. This prompts Medicare Advantage plans to implement cost-cutting measures, such as programs to keep their enrollees healthy, implement networks, and require prior authorization restrictions for care.

“Medicare Advantage plans may have lower premiums and / or additional coverage in some areas, but this value is not enough for patients in more restrictive provider networks that prevent them from accessing the care they need. need, ”Park said. “We found that satisfaction levels with reimbursable expenses had very little influence on patients who decided to change their plan. “

Data were collected from a nationally representative sample of people over the age of 65 from the Medicare Current Beneficiary Survey from 2010 to 2016 (expected for 2014, when data was not reported. ), including demographics, socioeconomic characteristics, health data and satisfaction with care. Rural residence was based on 2013 county-level data from the Department of Agriculture.

The authors suggest the importance of developing policies to encourage health workers to practice in rural areas. For example, loan repayment or forgiveness programs can attract needed health professionals to areas of scarcity. In addition, the federal government could consider changing the Medicare Advantage network adequacy standards for rural areas to ensure that there are enough providers included. Finally, offering a rural payment add-on for Medicare Advantage plans that work in rural areas can improve access to high-quality Medicare Advantage plans among rural registrants.

In addition to Park, the authors of this article include David J. Meyers, PhD, of Brown University and lead author Brent A. Langellier, PhD, from the Drexel School of Public Health in Dornsife.

This study was funded by a grant from the National Institute on Aging, National Institutes of Health.


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