Findings in a recent survey of beneficiaries push back on criticism of the service's administration.
While Medicare Advantage (MA) has come under scrutiny for administration issues, members of the service are overwhelmingly satisfied with their coverage, according to a survey by eHealth.
The licensed broker of Medicare insurance plans surveyed 2,848 MA enrollees in May and found that nearly nine in 10 members (88%) are happy with their plan.
Nearly two thirds (63%) say they are "very satisfied" with their MA plan, while 25% say they are "somewhat satisfied", 7% say they are neither satisfied nor dissatisfied, and 6% express dissatisfaction.
Among those that are dissatisfied with their plan, 29% cite lack of coverage for their preferred doctors, hospitals, or pharmacies. Another 25% cite out-of-pocket costs, while 22% take issue with their prescription drug coverage.
Still, 86% of enrollees would recommend it to family and friends in need of Medicare coverage, with only 3% saying they would not. More than half of members (51%) like their plan because it covers their preferred doctors, hospitals, and pharmacies, while 49% cite affordable monthly premiums, and another 49% say it covers their prescriptions drugs at a price they can afford.
Nearly half of enrollees (46%) say they chose MA because they wanted all their Medicare benefits wrapped up in a single plan.
The survey comes on the heels of a report by the Office of Inspector General (OIG) that found Medicare Advantage organizations (MAOs) often unnecessarily deny prior authorizations.
The OIG reported that 13% of prior authorization denials met Medicare coverage rules and 18% of payment denials met Medicare coverage and MAO billing rules.
Weeks later, the Improving Seniors' Timely Access to Care Act surpassed 290 co-sponsors, setting it up to be considered by the House of Representatives.
The bipartisan legislation, which has gained the support of several provider and patient advocacy groups, as well as Better Medicare Alliance, would reform prior authorization processes for MA plans.
Respondents in the eHealth survey also detail their experience with prior authorization denials, with 13% saying they had a claim or request denied. Only 3% say they were denied coverage for a specific prescription drug, while 2% were denied coverage for visits with specific doctors, and 1% were denied coverage for inpatient hospital care. The survey notes that many of the members that experienced denials were declined for services like dental and vision care, which aren't typically covered by Medicare.
Of those who had a claim or request denied, 43% say they were informed it was excluded from coverage under their plan. An additional 15% say their coverage was denied because the service or supply was determined to be unnecessary. Another 15% say that after their claim or request was initially denied, it was eventually paid by their insurer.
"This expansive survey of more than 2,800 Medicare Advantage enrollees confirms what we already know: Medicare Advantage remains highly popular among the audience that matters most – beneficiaries – despite misleading attacks from outside groups that seek to undercut the care and coverage that more than 28 million Americans rely on," Mary Beth Donahue, president and CEO of the Better Medicare Alliance, said in a statement.
"Further, this survey reaffirms that, overwhelmingly, prior authorization is applied appropriately and selectively as a clinical tool to coordinate care for beneficiaries."
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
Of the 2,848 Medicare Advantage enrollees surveyed, 88% say they are pleased with their plan.
The survey also found that 13% of respondents have experienced a claim or prior authorization request denial.
The positive response by MA members follows criticism of the service by media and the government, particularly when it comes to prior authorization delays or denials.