MA enrollees constrained by prior auth but docs more likely to ask about health assessments: report

Medicare Advantage (MA) beneficiaries are more likely than traditional Medicare enrollees to experience delays in care while they wait for prior authorization approval, but MA members are more to likely take advantage of supplemental benefits and be asked by docs to undergo a health assessment, a new survey from the Commonwealth Fund finds.

The report contrasted the differences between the two programs. In recent months, MA has come under fire for its more limited provider network and stringent prior authorization requirements. But advocates argue the program offers more robust benefits, like meal delivery and fitness perks, and an out-of-pocket maximum.

"Whether enrolled in Medicare Advantage or traditional Medicare, beneficiaries reported similar access to benefits, services, and providers as well as similar challenges and experiences," the report said.

However, while two-thirds of all respondents said their MA or traditional Medicare coverage met expectations, 22% of MA enrollees experienced delays in receiving care because of needing insurance approval for a test or procedure, versus just 13% of traditional Medicare beneficiaries. More than one-third of respondents said they had to wait longer than a month to see a doctor, no matter what the type of insurance coverage.

When asked if they couldn't afford care because of copayments or a deductible, 12% of MA members said they couldn't. Just 7% of traditional Medicare enrollees agreed, indicating a statistically significant difference.

More than half of people in MA plans were asked by their doctors to partake in health assessments (compared to just one-quarter of Medicare participants), but most people said it didn't affect their care plan.

Health assessments can help coordinate care management activities for people with chronic conditions, the analysis said. Federal payments to MA plans can vary based on data from health assessments because it shows member health status and care utilization.

For MA enrollees, 7 in 10 people used supplemental benefits in the past year, while 4 in 10 used dental or vision benefits or an allowance for OTC medications.

About 3 in 10 respondents said they are unsure what benefits are available to them in their health plan.

“It is critical that people receive the care they need at a cost they can afford, no matter which type of coverage they choose," said Gretchen Jacobson, the study author and vice president of advancing Medicare at the Commonwealth Fund, in a news release. "As more older adults shift into Medicare Advantage plans and its cost to the federal government grows, it is important to ensure that both programs deliver value to Medicare beneficiaries.”