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Medicare Advantage in the Hot Seat: Challenges and Opportunities Part 2

Analysis  |  By Jay Asser  
   June 01, 2023

The second preview of HealthLeaders Payer Week, five days of in-depth coverage and exclusive interviews.

HealthLeaders Payer Week features five days of in-depth coverage spotlighting the significant roles and contributions of insurers. Our week-long exploration, Medicare Advantage in the Hot Seat: Challenges and Opportunities, will include:

  • Medicare Advantage's tremendous market growth and expansion
  • The sticky business of Medicare Advantage prior authorization and marketing
  • The intersection of benefit design and provider performance
  • Rising drug costs and Medicare Advantage health plan counter-moves
  • The Star Ratings program evolution

Below is some of what you can expect for Payer Week. Part one previewed drugs costs and coverage, star ratings, and the Medicare value-based insurance design program.

Preview 1: Deceptive marketing and the role it plays in luring seniors

One aspect of Medicare Advantage that has come under great scrutiny is how plans market to new and existing enrollees. Seniors are often the target of misleading and inaccurate advertising, which only creates confusion for Medicare beneficiaries attempting to choose what plan suits them best.

Where is that marketing coming from and what regulations can combat it? Lawmakers have set their sights on these deceitful tactics and CMS has stepped in to impose tighter restrictions on how plans can attract members.

Preview 2: Can I have your approval, please?

Prior authorization can be problematic in any health plan, but it's been particularly burdensome in Medicare Advantage. And despite it being recognized as a glaring issue, the prior authorization headache in the private program seemingly isn't getting any better.

It's first and foremost leading to situations where necessary care is delayed or denied, but it's also putting increased administrative pressure on providers at a time when hospitals, health systems, and practices are feeling the financial and workforce squeeze.

Preview 3: Will the growth boom quiet down in 2024?

For the first time ever this year, Medicare Advantage became the coverage provider for more than half of all eligible Medicare beneficiaries. The growth has been steady and consistent over recent years and it's unclear when it will slow down.

However, CMS has thrown a monkey wrench into the works with some of its regulations, especially the risk adjustment changes which may impact how payers operate. Plans have experienced record enrollment, but competition is also as high as ever.

Preview 4: Checking under the supplemental benefits hood

Nearly all Medicare Advantage plans offer supplemental benefits and those offerings can entice enrollees in ways traditional Medicare can't. Yet encounter data on utilization of those benefits is still limited.

Better understanding how supplemental benefits impact beneficiaries can potentially further unlock Medicare Advantage, but that could require implementing standardization and reporting measures that are currently not in place.

Jay Asser is the contributing editor for strategy at HealthLeaders. 


As Medicare Advantage enrollment grows, so does scrutiny: Is Medicare Advantage really a better deal for beneficiaries?

Payer Week will shine a light on the program’s hidden and plain-sight hotspots.

These range from prior authorization and drug costs to a possible Part D market collapse and whatever happened to “VBID-X” benefit design.

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