Once eligible for Medicare, the percent of 66-year-olds who experienced barriers in care access was halved and 46 percent fewer seniors avoided care due to healthcare costs.
Medicare coverage increases seniors’ access to care and reduces affordability barriers, a study published in Health Affairs discovered.
“The Medicare program pays for roughly one of every four physician visits in the United States, and in 2019 it covered roughly 60 million people. The program has also long enjoyed favorable public opinion among both seniors and the nonelderly,” wrote the researcher.
“Yet although its scope is broad and opinion among beneficiaries is favorable, a rigorous understanding of how Medicare currently affects access to health care for its enrollees is not available. The greater health needs and lower income of its primarily elderly and disabled population, as well as the high cost of health care, underscore the importance of assessing how Medicare beneficiaries perceive the affordability of their care.”
The study leveraged data from the 2008–17 Medical Expenditure Panel Survey– Household Component (MEPS-HC) as well as the 2008–18 National Health Interview Survey. It compared access to care and care affordability measures between 64 year olds who are pre-Medicare eligibility age and those who were 66 years of age and are Medicare eligible.
The results showed that seniors reported slightly better care access and affordability when they were eligible to enroll in Medicare.
Once they were able to enroll in Medicare, the amount of seniors who said they experienced barriers in access to care dropped by 50.9 percent, such that 1.5 percent of the 66 year old respondents reported this issue.
Additionally, the share of those who said they had access to care but could not afford it dropped 46.0 percent, with 3.7 percent of 66 year olds reporting affordability as a barrier to care. While the number of Americans who encountered affordability barriers in healthcare decreased with age, there was a significant decline after age 64.
When the researcher compared pre-Affordable Care Act statistics with post-implementation results, there was no significant difference in these measures.
“Because Medicare payment rates are often below those set by private payers, it would not be surprising to have found a worsening of access on measures dealing with whether doctors accepted Medicare as insurance, whether respondents had trouble finding a doctor, or whether waiting times were too long,” the study postulated.
However, the research indicated otherwise. Instead of a decline in access to and affordability of care after enrolling in Medicare, seniors reported a slight improvement. This trend continued, in spite of the fact that health tends to decline with age, exacerbating opportunities for barriers in access to care or healthcare costs.
Access to care improved for seniors without a college degree. The researcher tied this development to the ubiquity of Medicare and the fact that, prior to reaching Medicare eligibility, these seniors may have been in jobs that left them underinsured or uninsured.
Affordability improved for non-Hispanic White or Hispanic seniors, when compared to Black seniors.
“When looked at by race and ethnicity, the smaller improvements on affordability measures for non-Hispanic Blacks compared with non-Hispanic Whites may be a reflection of their higher pre-sixty-five enrollment in Medicaid, which requires minimal cost sharing and thus allows less room for improvement when one enrolls in Medicare,” the study suggested.
Dental, prescription drug, or specialist coverage were more affordable for seniors after they became Medicare eligible.
These decreases in barriers to certain supplemental benefits may have been the result of the fact that more Medicare Advantage plans cover these benefits. In fact, prescription drug coverage draws many Medicare-eligible seniors to Medicare Advantage plans.
These results, which demonstrate that Medicare improves affordability and access to care, could be especially important in light of the current presidential administration’s intentions to expand the age of Medicare eligibility or provide a buy-in option.
However, the study’s results did not necessarily support widespread adoption of Medicare.
“Compared with younger populations, a higher proportion of the near-elderly are covered by private insurance, and a smaller share are uninsured,” the researcher explained.
“The near-elderly also have greater health needs than middle-aged people. These attributes may influence whether and how the effects presented here may generalize outside of the samples used in this analysis. The relatively high needs of the near-elderly may have contributed in ways that would not generalize to younger cohorts.”
Instead, the study’s outcomes may be more applicable for policymakers considering a lower age of eligibility for Medicare.
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By Samantha Liss – HealthCareDive – February 3, 2021
Anthem has entered into a deal with InnovaCare Health to acquire its Puerto Rico subsidiaries, which include Medicaid and Medicare Advantage plans, the payer said Tuesday. Financial terms of the deal, expected to close by the second quarter, were not disclosed.
Anthem's entrance into Puerto Rico will net the Indianapolis, Indiana-based insurer the largest Medicare Advantage plan and the second-largest Medicaid plan on the island, which conduct business as MMM.
Anthem touted that MMM has a network of specialized clinics with more than 10,000 providers across Puerto Rico, allowing for a more whole-health experience.
Anthem's government business fueled the bulk of its enrollment growth in 2020 as commercial enrollment was stagnant.
Overall, Anthem's government business experienced a growth of nearly 17% year over year from 2019 to 2020, while the commercial and specialty unit increased just 0.2%.
As part of this latest deal, Anthem is poised to add more than 572,000 government members, a significant one-time pickup.
Anthem is set to gain more than 267,000 MA members in the MMM plan, which is the ninth-largest MA plan in the country, according to Anthem, which ended 2020 with 1.4 million MA members, a nearly 18% increase from 2019.
Its Medicaid book of business will add more than 305,000 members through the deal, which needs approval from various regulators including the Commonwealth of Puerto Rico. Anthem's Medicaid business pegged enrollment at nearly 9 million at the end of 2020, about a 22% increase from its 2019 Medicaid enrollment.
2021 EPS guidance will not change as a result of the acquisition, Anthem said.
Anthem cut its outlook for 2021 as it experienced a rebound in care in the fourth quarter, which weighed heavily on its quarterly profit. Although some insurers reported large profits during periods of 2020 as members deferred care due to the pandemic, companies have warned the trend will ultimately swing in the opposite direction when patients return for care they put off. Insurers expect some members may even be sicker as diagnoses went undetected.
Anthem is acquiring the units from InnovaCare and its equity investor Summit Partners, which has invested in a slew of healthcare companies, including U.S. Renal Care, a dialysis operator and MD VIP, a concierge physician practice.
Deft Research recently published the 2021 Medicare Shopping and Switching Study. This national market research report of over 3,400 seniors details the shopping and switching habits of these consumers during the most recent Annual Election Period.
In 2020, more carriers, agencies, and consultants relied on the decision-making power of this study than ever before.
Deft's first Executive Research Brief takes a closer look at key report findings linked to CMS benefit design changes. For the 2021 plan year, CMS increased the top value for maximum out of pocket (MOOP) from $6,700 to $7,550. CMS also instituted a Part D Savings Model which limits some insulin copayments to $35.
Deft's study reveals the impact on consumers when MAPD's act on these changes.
An increase in MOOP of just $100 leads to disenrollment.
In a market where plan designs are not very different from each other, the value of the MOOP stands out as a competitive advantage or disadvantage.
Diabetics who switched plans favored enrollment Part D Savings Models.