Medicare Advantage
The difference in care between Medicare and Medicare Advantage members
With the increasing enrollment by Medicare recipients in Medicare Advantage health plans and the issue of prior authorization requirements and limited provider networks, a team of health policy researchers at Harvard T.H. Chan School of Public Health looked at the…
A costly mistake for many Medicare Advantage enrollees
A recent study by a leading healthcare system found that people on Medicare Advantage plans are not utilizing dental and vision supplemental benefits provided by their health plan. One of the major draws for a Medicare recipient to choose a…
Who is enrolling in Medicare Advantage?
The creation of Medicare Advantage health plans was part of the 1997 Balanced Budget Act. Medicare Advantage grew from almost zero in 1998 to 33.8 million subscribers in 2024, or 55 percent of Medicare recipients. One reason Medicare recipients enroll…
You have to March 31st to change your Medicare Advantage plan
Are you enrolled in a Medicare Advantage plan you’re not sure is right for you? You can make changes to your health and prescription drug coverage during the Medicare Advantage open enrollment period, which started January 1 and runs through…
Turmoil in the privatized version of Medicare
Humana, Inc., has reported $1.2 billion in 2024 profits, which included a $693 million fourth-quarter loss as the health insurer exits unprofitable Medicare Advantage markets for 2025. However, Humana is not alone. CVS and Centene have also warned that they…
Medicare Advantage insurers and prior authorization determinations in 2023
Medicare Advantage members, 99 percent, are required to obtain prior authorization for higher-cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. Insurers will use prior authorization and provider networks to manage utilization and lower costs. The…
Unmet dental needs of Medicare Advantage members
According to a recently published study in the JAMA Health Forum, Medicare Advantage dental plans may create barriers to dental care access for seniors despite the plans’ intended purpose of expanding coverage. Medicare Advantage Members with dental benefits reported higher…
Medicare Advantage enrollment has increased
Of the Medicare-eligible individuals, 54 percent are enrolled in Medicare Advantage plans. Why has Medicare Advantage plan enrollment increased as rapidly as it has? According to new research, the Medicare Advantage plan’s ability to cover extra benefits, reduce premiums, and…
Does Medicare Advantage have better access to extra services?
A study by researchers at Mass General Brigham found that despite Medicare Advantage plans offering enhanced dental, vision, and hearing services, Medicare Advantage beneficiaries did not outperform their traditional Medicare counterparts in utilizing these benefits. Todd Shryock asks whether Medicare…
CMS proposes $21B payment increase for Medicare Advantage in 2026
CMS has released a new advanced notice to increase payments to Medicare Advantage plans in 2026. CMS expects to spend $9.2 trillion over the next decade in an “effort to provide access to affordable, high-quality care in Medicare Advantage while…