Prior authorization can lead to delays
A major focus of the Commonwealth survey was to determine whether people’s experiences with Medicare differed based on whether they are enrolled in original or an Advantage plan. “Overall, it appears that the experiences of people are similar regardless of their type of coverage,” Jacobson says. “The bottom line is that people seem to be relatively happy with their coverage.”
Sixty-five percent of enrollees in original Medicare and in Medicare Advantage said that their coverage “fully” met their expectations. Another 31 percent of MA plan members and 28 percent of original Medicare beneficiaries said the program “somewhat” met their expectations.
There was a difference, the survey found, when it came to people who reported their care was delayed because it needed advance approval, often called prior authorization. Among those with an MA plan, 22 percent said their care was delayed while they waited to get it approved, while only 13 percent of respondents with original Medicare had to wait for an OK.
“Improving the prior authorization process is a priority for CMS,” Seshamani says. “In MA, CMS is removing barriers to ensure MA enrollees get the care they need and are entitled to.” CMS officials pointed to a new regulation designed to streamline the prior authorization process by, for example, improving the electronic exchange of health information.
Extra services underutilized
Medicare Advantage members who took the survey were also asked about their use of the extra benefits that MA plans are authorized to offer. These include such services as dental, vision and hearing care, services that are not covered under original Medicare.
The survey found that 69 percent had not used any of their supplemental benefits, and about a quarter of those respondents said they didn’t use them because they didn’t know what benefits they had, Jacobson said. Forty-two percent said they used their dental benefit and 41 percent said they used their vision benefit.
CMS officials have recognized that often enrollees do not take advantage of some of these extras. Under a proposed regulation, expected to be finalized this year, halfway through each year insurers will have to send a letter to enrollees letting them know what services they are entitled to but haven’t used.
“This new policy should really help those beneficiaries who weren’t aware of what benefits their plan offered,” Jacobson says.
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.