Study Shows High-Cost MA Plans Don’t Always Result In Better Care

Seniors on Medicare Advantage health plans may not always be receiving high quality care, a new study shows.

The study from RAND Corporation, a nonprofit research organization, looked at 15 different quality measures from patients on MA plans during 2016 and 2017 and found that the quality of care was only slightly better when compared to plans that didn’t have any monthly premiums.

The study’s authors concluded that paying higher premiums is not always necessary when seniors are trying to receive high quality care from an MA plan.


“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,” Amelia M. Haviland, a professor of statistics and public policy at Carnegie Mellon University and an adjunct statistician at RAND, said in a press release.

In recent years, MA has continued to play an even larger role in the federal Medicare program, with over 28 million beneficiaries enrolled in the U.S.

However, home-based care providers have often faced challenges contracting with plans. One of the reasons being is that the rates plans pay for home health care services are not typically on par with traditional fee-for-service Medicare. Personal home care providers also find the rate structure for their services to be economically unstable.


One of the gripes home-based care providers have had with MA plans, in general, is their marketing tactics. Executives have told Home Health Care News time and again that they find those misleading.

When selecting a health care plan, beneficiaries typically prioritize premium costs and co-pays. MA plans are usually able to save consumers money, but that is dependent on the care they need.

Earlier this summer, amidst some strong pushback from industry leaders, the Centers for Medicare & Medicaid Services (CMS) put out a request for public comment on the MA program.

“We see a huge opportunity for partnership with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs and how Medicare Advantage is working for enrollees,” Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said in a news release. “It’s important that CMS engage as many stakeholders as possible to achieve our collective vision of equity, access, quality and affordability.”

To find the link between quality and cost of care, RAND researchers looked at beneficiaries with and without monthly premiums and compared factors like whether a patient received recommended cancer screenings, whether high blood pressure was controlled, whether diabetes was treated adequately and more.

Across most measures taken into account, patients enrolled in the two higher-premium plan tiers reported similar or slightly better experiences on average than enrollees in the lower-premium categories.

“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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