Links about higher Med Adv costs

Topics I have covered this year in Medicare Advantage are an article on denial rates (per Health Affairs report), an article on denial rates (per OIG), and a very recent big proposal from HHS to require Medicare Advantage to switch prior authorization procedures into standardized computer portals or formats by 2026  (1,2,3)

 

The best source I have on the higher costs of Medicare Advantage is a 2021 Kaiser information report:

 

https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage-enrollee-adds-to-medicares-solvency-and-affordability-challenges/

 

This tracks to a MEDPAC report that shows that current MA spending is about 4-5% higher per head (I assume risk adjusted)

https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf#page=401

 

See also a November 2021 article at NPR on the topic, underlying links not as clear as I'd like:

https://www.npr.org/sections/health-shots/2021/11/11/1054281885/medicare-advantage-overcharges-exploding

 

Of course, data can always be read in different ways (!!), and there is a headline from America's Health Plans AHIP that MA costs less if interpreted correctly.  This is Sept 2022

 

https://www.ahip.org/news/press-releases/new-study-medicare-advantage-costs-less-than-original-medicare

 

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Footnotes

 

1 MA denial rates (mostly labs!!)

http://www.discoveriesinhealthpolicy.com/2022/01/new-study-documents-medicare-advantage.html

2 MA Denial rates (OIG)

http://www.discoveriesinhealthpolicy.com/2022/04/more-data-on-medicare-advantage-denials.html

3 New HHS rulemaking on national prior auth portals and standards by 2026

http://www.discoveriesinhealthpolicy.com/2022/12/brief-blog-hhs-proposes-widespread.html