By GEORGE HALVORSON
The Medicare Advantage (MA) program has greatly benefited millions of low-income retirees by providing better retirement benefits and support services. MA plans have helped save Medicare by reducing costs and improving care for half of its beneficiaries. This has ensured the protection of the Medicare Trust Fund against future deterioration. The capitation paid to MA plans is based on the actual average cost of fee-for-service Medicare in each county, with payments running about 11% below that average cost.
MA plans consistently bid capitation levels below the average cost of fee-for-service Medicare each year because they deliver superior care. It is a functional truth that better care costs less money when the system and processes are designed to achieve that result. Fee-for-service Medicare is often expensive and poorly delivered, resulting in higher costs for unnecessary care. MA plans focus on improving care outcomes, such as reducing diabetic blindness by 60% through blood sugar control.
Mortality rates for patients undergoing amputations are over 40%, a significant expense for Medicare. MA plans have been able to reduce amputations by focusing on preventative care, such as keeping patients’ feet dry and clean. This has not only saved billions of dollars but also improved the life expectancy of diabetic patients significantly.
Special Needs Plans (SNP) now serve over 6 million people, providing essential healthcare support to those with the highest level of needs in the Medicare program. Additionally, MA plans offer additional benefits such as vision, dental, and hearing care, as well as various social support services not available in traditional Medicare. These benefits are funded by surpluses created through better care outcomes and do not increase the overall cost of Medicare.
Low-income retirees, who often lack adequate retirement savings, greatly benefit from the expanded benefits offered by MA plans. These benefits are particularly relevant to African American and Hispanic enrollees who have lower retirement savings on average than their White counterparts. The higher satisfaction levels among MA plan members are a testament to the importance of these additional benefits in their daily lives.
Critics of MA plans often overlook the significant impact these plans have on improving care outcomes and reducing costs for Medicare beneficiaries. Instead of focusing on benefit reductions, they should acknowledge the real-life benefits and improved quality of care provided by MA plans. Additionally, CMS has improved its data and processes for determining capitation levels to ensure the sustainability and effectiveness of the MA program.
Overall, MA plans have proven to be a valuable asset to Medicare, providing better care and additional benefits to millions of low-income retirees. Their focus on preventive care, improved outcomes, and overall cost savings demonstrate the success of the program in meeting the needs of its beneficiaries.
