A recent decision by the U.S. Department of Health and Human Services to promote enrollment in high-quality Medicare Advantage signals a renewed focus on consumer preferences and patient outcomes. That trend toward quality will continue to be a key driver in the changing healthcare landscape, affecting both plans and providers in the future.
HHS Secretary Kathleen Sebelius recently announced that Medicare is doing more to promote enrollment in high quality plans. Now, persons enrolled in consistently low performing plans (those receiving less than 3 of 5 stars for at least the past three years) will be notified about how they can change to a higher quality plan. In addition, 5-star plans are rewarded by being allowed to continuously market and enroll beneficiaries throughout the year.
“In 2013, people with Medicare will have access to a wide range of plan choices than ever before,” Sebelius said, noting there are now 127 four- or five-star Medicare Advantage plans that serve 37 percent of enrollees. In 2012, there were only 106 four- or five-star plans, serving only 28 percent of enrollees. People with Medicare will also have access to 26 four- or five-star prescription drug plans, which currently serve 18 percent of enrollees.
The Affordable Care Act also added new benefits to Medicare, such as phasing out the Medicare prescription drug coverage gap also known as the “donut hole.” In 2013, people with Medicare who reach the “donut hole” will receive approximately 53 percent off the cost of brand name drugs and 21 percent off the cost of generic drugs. Medicare beneficiaries will also continue to benefit from Medicare-covered preventive services at zero cost-sharing, including a yearly wellness visit. At the same time, premiums in the Medicare Advantage program are remaining steady, Sebelius said. From 2010 through 2013, Medicare Advantage premiums have fallen by 10 percent and enrollment has increased by 28 percent.
That’s a winning combination for people enrolled in Medicare plans, and a trend that providers should continue to follow closely.