Medicare Advantage receiving bipartisan support in House of Representatives

Photo: John Baggaley/Getty Images

More than 340 members of the U.S. House of Representatives, led by Reps. Brett Guthrie (R-Ky.), Tony Cárdenas (D-Calif.), Earl Blumenauer (D-Ore.), and Mike Kelly (R-Pa.), signed a letter late last week to the Centers for Medicare and Medicaid Services, urging the agency to maintain stability with Medicare Advantage, contending that it provides affordable, high-quality health coverage.

In total, 346 representatives signed the letter, topping the previous record of 339; this amounts to 80% of the chamber. It comes as CMS prepares its annual rate-setting process, in which the agency will announce key decisions related to Medicare Advantage beneficiaries' funding for the 2023 plan year.

In the letter, lawmakers urged CMS to "provide a stable rate and policy environment that ensure Medicare Advantage can continue to provide the affordable, high-quality, patient-centered coverage our constituents rely on every day." They went on to express a desire to work with CMS "to ensure that, through Medicare Advantage, tens of millions of older adults continue to have access to comprehensive, affordable, health coverage choices."

The Congressional letter follows polling in Morning Consult that shows 92% of Medicare Advantage beneficiaries consider a candidate's support for the program as important to earn their vote.

WHAT'S THE IMPACT?

In urging CMS to maintain the stability of the Medicare Advantage program, the representatives pointed to statistics from Kaiser Family Foundation showing that enrollment in MA has almost doubled over the past decade, with more than 43% of Medicare beneficiaries choosing to enroll. 

The signers also highlighted CMS' own data showing 90% of MA enrollees are in a plan with a quality rating of four or more stars. They maintained MA "consistently delivers better care and value that provides beneficiaries with more coordinated access to high-quality providers and lower avoidable hospital and emergency department visits."

The lawmakers peppered CMS with additional statistics indicating 41% fewer avoidable acute inpatient hospital stays among MA beneficiaries, as well as higher rates of utilization of preventive services, compared to traditional Medicare. It also holds appeal across different socioeconomic subgroups, with 40% of enrollees making less than $25,000 per year.

During the pandemic, Medicare Advantage enrollees experienced a 19% lower rate of hospitalization compared to original Medicare, lawmakers said.

"As a result of care coordination and greater flexibility in plan benefit offerings, Medicare Advantage enrollees have more access to the care and support they need, as well as supplemental benefits that help them manage their health," the letter read. "This access to high-quality care has helped older adults and people with disabilities on Medicare Advantage stay healthy and safe throughout the pandemic."

The lawmakers asked the administration to provide a stable rate and policy environment for Medicare Advantage, including protecting important benefits such as programs focused on addressing health equity, in-home health risk assessments and value-based insurance design.

"We are committed to ensuring that our more than 27 million constituents who rely on Medicare Advantage can count on stability in the program and do not face uncertainty about their benefits or premiums next year," they wrote.

THE LARGER TREND

Insurers are expanding their Medicare Advantage offerings at a decent clip, with Humana announcing last fall it would debut a new Medicare Advantage preferred provider organization (PPO) plan in 37 rural counties in North Carolina in response to market demand in the eastern part of the state.

The insurer, however, is drastically reducing its Medicare Advantage enrollment estimates for 2022 due to a large number of terminations during the last enrollment period, revealing in a recent filing with the Securities and Exchange Commission that the former projection of 325,000 to 375,000 new MA members has been slashed to 150,000 to 200,000 new members.

Humana also expects group MA membership to be generally flat throughout this year, as it doesn't anticipate any large accounts will be gained or lost.

Other insurers remain undeterred for now. UnitedHealthcare, which already has significant market control with its MA plans, said it will strengthen its foothold in the space by expanding its MA plans in 2022, adding a potential 3.1 million members and reaching 94% of Medicare-eligible consumers in the U.S.

For the third straight year, health insurer Cigna is expanding its Medicare Advantage plans, growing into 108 new counties and three new states – Connecticut, Oregon and Washington – which will increase its geographic presence by nearly 30%.

Centene is also getting in on the act, expanding MA into 327 new counties and three new states: Massachusetts, Nebraska and Oklahoma. This represents a 26% expansion of Centene's MA footprint, with the offering available to a potential 48 million beneficiaries across 36 states.

CMS said in late September that the average premium for Medicare Advantage plans will be lower in 2022 at $19 per month, compared with $21.22 in 2021. However, Part D coverage is rising to $33 per month, compared with $31.47 in 2021.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com