Medicare Advantage beneficiaries were less likely to be hospitalized and die from COVID-19 during the first nine months of the pandemic compared with their fee-for-service counterparts, a new report finds.
From January to November 2020, individuals enrolled in the privatized Medicare plans made up 36% of hospitalizations among Medicare beneficiaries, despite representing 40% of eligible enrollees, according to a study released Thursday by research firm ATI Advisory.
Meanwhile, traditional, fee-for-service enrollees represented 64% of Medicare hospitalizations despite making up 60% of all eligible enrollees, according to the study, which is the third published analysis of how Medicare coverage influences COVID-19 outcomes and access to care. Half of all traditional Medicare members who were hospitalized with coronavirus were over 75-years-old, compared with 57% of Medicare Advantage members.
Those who were enrolled in traditional Medicare also had a higher mortality rate than those in Medicare Advantage. Twenty-two percent of fee-for-service beneficiaries hospitalized with coronavirus died during their visit, compared with 15% of Medicare Advantage enrollees.
The report relies on Medicare Current Beneficiary Survey data and is sponsored by Washington D.C.-based Better Medicare Alliance, a Medicare Advantage advocacy group supported by health insurers. While its findings around better patient outcomes in Medicare Advantage have been supported in past studies that were not commissioned by interest groups, its conclusion that enrollees in the privatized program were better able to access care contradicts previous research, which has found large portions of members are limited to narrow networks and, in some instances, been unable to receive treatment.
"Risk-bearing entities, whether it be Medicare Advantage plans or providers, were able to act more quickly and more nimbly because they were risk-bearing," said Allison Rizer, principal and lead researcher at ATI. "They already had administrative processes in place that they were able to leverage, and they had the flexibility in dollars that they were able to deploy differently based on the very rapidly evolving needs of individuals during the early stages of COVID."
Those aren't the only differences, however, the demographics between the Medicare programs differ.
As Medicare Advantage has matured, its population has grown younger, and included greater proportions of racial and ethnic minorities and as well as low-income beneficiaries, according to the Commonwealth Fund. While chronic conditions have not become more common among enrollees, the Commonwealth Fund noted that a greater proportion of members have complex medical needs. By offering supplemental benefits around seniors' medical, social and emotional needs that traditional Medicare does not offer, Medicare Advantage health insurers aim to achieve better health outcomes for their members at lower costs, allowing them pocket additional profits.
Benefits around food, transportation and economic support likely contributed to members' more positive outcomes, Rizer said. Those historically are more commonly provided by private insurers.
Despite lower hospitalization and mortality rates, nearly twice as many Medicare Advantage beneficiaries, or 7%, who received a COVID-19 test reported a positive result, compared with 3% of fee-for-service members. The study said that members enrolled in both programs had equal access to testing services. But racial and ethnic minorities enrolled in Medicare Advantage were less likely to actually be tested.
Twenty-six percent of Black Medicare Advantage members had been tested for COVID-19 by November, compared with 30% of traditional members; and 24% of Latinx Medicare Advantage members had ever been tested, compared with 29% of fee-for-service Latinx individuals. Both groups contracted the virus at higher rates and were more likely to die from COVID-19 than whites.
Medicare Advantage members were also more likely to be hesitant to receive a COVID-19 vaccine, with 43% saying they felt reluctant getting inoculated compared with 40% of fee-for-service enrollees. The study was conducted before any of the COVID-19 vaccines were widely available.
"Medicare Advantage tends to enroll lower-income population generally, and there was more reluctance on behalf of lower-income individuals to get tested or to even have access to testing," Rizer said. "That could be driving this."
Still, for private insurers, engagement among dual-eligibles represented a bright spot, the ATI study said.
Among those who qualify for Medicare and Medicaid, 92% of dual-eligibles enrolled in Medicare Advantage plans reported access to urgent care, compared with 84% of fee-for-service enrollees; 78% said they could get diagnostics, compared with 66% of traditional beneficiaries; 68% of Medicare Advantage members received care for an ongoing condition, compared with 63% of fee-for-service; and 58% of Medicare Advantage members were confident in their ability to get a regular check-up, compared with 43% in traditional Medicare.
While Medicare Advantage and traditional Medicare members reported the same likelihood of accessing care during the pandemic, individuals enrolled in only Medicare Advantage were more confident they could get diagnostics, access to dental care and receive treatment for an ongoing condition.
These findings contradict several academic studies which have repeatedly found lower utilization among Medicare Advantage members compared with traditional Medicare, with academic estimates ranging from 10% to 60%. A 2019 study in the American Economic Journal: Applied Economics, for example, found Medicare Advantage spending to be 30% lower per member per month than traditional Medicare.
"Some of the early policy flexibilities that CMS was affording to Medicare Advantage plans with respect to like benefit design was really helpful in getting targeted benefits out to the most complex beneficiaries," Rizer said.
Although fewer Medicare Advantage beneficiaries had access to the internet during this time, the study said more of them accessed telehealth during the pandemic, particularly audio-only visits with their providers. Ninety-four percent of Medicare Advantage beneficiaries were able to access clinicians via audio appointments, compared with 87% of fee-for-service Medicare beneficiaries.
Health insurers and provider groups have been lobbying the Centers for Medicare and Medicaid Services for permanent coverage of audio-only telehealth, although the two disagree over how the service should be reimbursed. Both agree that, without coverage, broadband access represents a social determinant of health.