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Insights & Articles


RAND STUDY: HIGHER PREMIUMS NOT ALWAYS LINKED TO BETTER QUALITY IN MEDICARE
ADVANTAGE PLANS

By Ilene MacDonald, Editorial Director | August 31, 2022

Enrolling in a higher-cost Medicare Advantage (MA) plan may not always provide
seniors with better-quality health care, according to a new RAND Corporation
study, which took a retrospective look at quality measures among plans in 2016
and 2017.

Researchers examined 15 different measures of quality among large representative
samples of people enrolled in MA plans during 2016 and 2017. They found that
plans that charged a higher monthly premium provided on average only slightly
better care as compared to plans with no monthly premium.

Quality varied substantially within each premium cost tier studied, with
high-quality care being observed among a number of plans in each of the cost
tiers. More than 700 MA plans were part of the analysis.

The findings were published in the latest edition of JAMA Health Forum.

“Paying higher premiums is not necessary to receive high-quality care from a
Medicare Advantage plan,” said study lead author Amelia M. Haviland, a professor
of statistics and public policy at Carnegie Mellon University and an adjunct
statistician at RAND, a nonprofit research organization, in the study
announcement. “Seniors should look at metrics other than premium costs alone
when looking for a Medicare Advantage plan that offers a high quality of care,
including direct measures of quality, such as Star ratings.”

Health care costs are a concern for both consumers and policymakers. People
enrolled in MA plans report that price measures such as premium costs and copays
are their primary consideration when selecting a plan.

But the findings conflict with a recent report from the Better Medicare
Alliance, which found that the average monthly premium for MA plans in 2022 is
$19, a 15-year low. MA members also reported they spent nearly $2,000 less on
out-of-pocket costs and premiums annually.

RELATED: The state of Medicare Advantage in 2022: BMA compiles the latest
findings on enrollment, access, value, and outcomes

To examine the link between premium cost and quality, RAND researchers analyzed
information about the care delivered to people enrolled in MA plans. About 40
percent of the enrollees were in plans with no monthly premium, while 6 percent
were in plans with a monthly premium of more than $120.

MA plans provide coverage for hospital and physician services like traditional
Medicare fee-for-service, but typically also offer additional services such as
coverage for dental care and eyeglasses. In exchange for additional services and
lower copays, members are restricted to in-network providers. In 2022, nearly
half of eligible Medicare beneficiaries are now enrolled in MA plans.

RELATED: MA moves closer to becoming predominant way seniors get their health
coverage and care

The information that RAND used to measure the quality of care from MA plans
included clinical quality measures based on administrative information such as
medical charts involving more than two million enrollees. Those quality measures
included items such as whether patients received recommended cancer screenings,
whether high blood pressure was controlled, and whether diabetes was treated
adequately.

The study also included surveys of more than 168,000 MA members who were asked
about their experiences with health care, prescription drug coverage, and their
plan. Those measures included the ability to get care, the ability to get care
quickly, and getting needed drugs.

Across most measures, people enrolled in the two higher-premium plan tiers
reported similar or slightly better experiences on average than enrollees in the
lower-premium categories. For example, people enrolled in the highest-premium
tiers were more likely to receive annual flu shots.

However, on one measure, lower-cost plans offered better care. People enrolled
in lower-tiered plans received better care on average for osteoporosis than
their peers enrolled in higher-premium plans.

“Given that many high- and low-quality plans were found in each of the premium
tiers we studied, the premium cost is a poor proxy for assessing the quality of
a Medicare Advantage plan,” Haviland said. “Making plan quality information more
accessible and salient to consumers is a key to reducing consumers' costs while
improving quality.”

 

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