There may be a clear point in the bleak landscape of U.S. health insurance — which 71% of Americans consider right or poor — is Medicare Advantage.
New research published today by eHealth (NASDAQ: EHTH) shows that people enrolled in Medicare Advantage plans are very happy with what they have achieved.
Of those who purchased a Medicare Advantage plan through the eHealth website, 88% were very or somewhat satisfied with the coverage and only 6% were satisfied. Nearly the same percentage (86%) said they would recommend Medicare Advantage to a friend or relative; Only 3% said they would not.
Medicare Advantage, also known as Medicare Part C, combines original Medicare (parts A and B with hospitalization and outpatient care) with other benefits, often including Part D prescription coverage and supplements such as dental, visual, hearing, and fitness benefits. including.
Nearly half of those surveyed (46%) chose the Medicare Advantage because they wanted all of their Medicare benefits in one plan.
Of those previously enrolled in other types of Medicare coverage, 61% said they preferred Medicare Advantage and 24% said they were just as happy with Medicare Advantage as they were with Medicare coverage.
Specifically, 59% of respondents who purchased Medicare Supplement plans, also known as Medigap, were satisfied with the Medicare Advantage plan. Two-thirds (67%) said Medigap was too expensive. A quarter said they preferred Medicare Advantage because Medigap does not offer drug coverage.
Other reasons why respondents chose to enroll in Medicare Advantage were preferred medical, hospital, and pharmacy coverage; prescription drug coverage; and cheap monthly premiums.
However, the same motivations for enrolling in Medicare Advantage were also the main reasons mentioned among the minority of respondents who stated that they were not happy with Medicare Advantage. For example, 29% of dissatisfied respondents blamed the lack of coverage for their preferred medical, hospital, or pharmacy coverage. Another 22% reported a lack of coverage for prescription drugs.
The survey also found a high level of price sensitivity among respondents. Nearly half (48%) said they could not pay monthly premiums and another 25% said they could only pay monthly premiums of less than $ 50. Three-quarters (74%) reported that they could only afford pocket costs of $ 1,000 or less per year.
These findings may help explain the growing popularity of Medicare Advantage plans.
In 2021, 26 million people — 42% of all Medicare beneficiaries — opted for the Medicare Advantage. Medicare Advantage enrollment has more than doubled in the last ten years.
According to the Kaiser Family Foundation, most Medicare Advantage plans (59%) that had prescription drug coverage on the market in 2022 (59%) did not receive additional monthly premiums (beyond the original Medicare Part B Medicare Part B premium). Almost all Medicare beneficiaries (98%) had access to the Medicare Advantage option, which included prescription drug coverage.
They are popular opportunities. Nearly two-thirds (65%) of those enrolled have opted for zero premium plans. Another 20% pay less than $ 50 a month for the Medicare Advantage plan, which covers prescription drugs.
The Medicare Advantage photo isn’t completely pink, though.
A federal report released in April 2022 suggested that Medicare Advantage plans could delay or deny medical care. A review of denied claims showed that 13% met Medicare coverage criteria, suggesting that Medicare Advantage plans were applying additional criteria not found in Medicare rules. In addition, the review found that some requests for additional documentation were not necessary. These findings suggest that Medicare Advantage plans were creating unnecessary burdens for patients to receive adequate care.
The latest report coincided with a high-level review of successful 2018 appeals. Beneficiaries tried to appeal against the denied claims, with 75% of the denials being annulled, firstly stating that they had been improperly denied.
In the eHealth survey, respondents reported relatively little denial of coverage. Overall, 13% have refused a claim or request for prior authorization. Many were denied coverage for a specific prescription (3%), visits to a specific doctor (2%), or hospitalization coverage (1%).
Of those who refused, 43% said the requested service was out of their plan’s coverage and 15% said the denial was because their request was not medically necessary. After all, 15% reported that the original denial was eventually canceled and paid for by their insurer.
Overall, eHealth results are well reflected in the Medicare Advantage option. The majority of respondents (61%) said they saw a good example of a Medicare Advantage public / private partnership.