Friday, November 7, 2014

Medicare Open Enrollment: Traditional Medicare vs Medicare Advantage

It’s the Medicare open enrollment time until December 7th and many Medicare beneficiaries are considering their options and trying to choose between traditional Medicare and a Medicare Advantage plan.  
I’ve given my two cents in a prior posting regarding why I chose to stick with traditional Medicare. See: Choosing Between Original Medicare and Medicare Advantage. But I realize that each beneficiary’s circumstances are different, and the factors that were important to me might not be quite so important to others.
If you are currently struggling with this choice, the Kaiser Family Foundation (KFF) has just released a helpful review of the literature comparing the quality and access provided under traditional Medicare and Medicare Advantage plans. Here is a link to the Kaiser review:
Here is an overview from the Executive Summary:
On the one hand, the evidence indicates that Medicare HMOs tend to perform better than traditional Medicare in providing preventive services and using resources more conservatively, at least through 2009. These are metrics where HMOs have historically been strong. On the other hand, beneficiaries continue to rate traditional Medicare more favorably than Medicare Advantage plans in terms of quality and access, such as overall care and plan rating, though one study suggests that the difference may be narrowing between traditional Medicare and Medicare Advantage for the average beneficiary. Among beneficiaries who are sick, the differential between traditional Medicare and Medicare Advantage is particularly large (relative to those who are healthy), favoring traditional Medicare. Very few studies include evidence based on all types of Medicare Advantage plans, including analysis of performance for newer models, such as local and regional PPOs whose enrollment is growing.
KFF notes that “studies comparing overall quality and access to care between Medicare Advantage plans and traditional Medicare tend to be based on relatively old data, and a limited set of measures.” Better evidence is needed. “At a time when enrollment in Medicare Advantage is growing, it is disappointing that better information is not available to inform policymaking.
Medicare’s blog recently noted that convenience can be an important factor in making a choice. See, Medicare Open Enrollment: the value of convenience.
Further Reading
Choosing Between Original Medicare and Medicare Advantage, Marshall Elder and Estate Planning Blog, April 8, 2013.
Medicare Open Enrollment: the value of convenience.

Apprise: A free health insurance counseling program that helps older Pennsylvanians with Medicare. Phone 1-800-783-7067. 

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