Patterns Likely to be Similar Nationwide
The Connecticut SHIP program, known as CHOICES, recently hosted an event showcasing the offerings of Connecticut Medicare Advantage (MA) plans for CHOICES counselors and other stakeholders. Representatives of six insurance companies that offer MA plans attended, while three others were absent. Several common themes arose from the presentations.
- Medicare Advantage organizations seem to be moving away from plans under the HMO model, with its more limited provider networks, and toward more PPO offerings, with “preferred” providers, but flexibility to use others, though generally at increased cost. One company will offer no HMO options at all in Connecticut for 2024.
- Relatedly, companies almost universally touted “national” coverage, by virtue of the more flexible PPO networks, in a clear response to years of criticism about access to care.
- Only one plan mentioned stand-alone Prescription drug plans (PDPs) versus MA plans, and then only to say that the stand-alone plans were “not competitive pricing, really.”
- Few representatives even mentioned Medicare supplemental (Medigap) plans, and written materials included no Medigap details. This aligns with reports that those offerings are not as profitable for Insurers as MA plans. One company did note that they offered new rates to be more competitive with their Medigap options.
- The MA representatives pushed hard on D-SNPs – Special Needs Plans for beneficiaries who are eligible for both Medicare and Medicaid. They accentuated limited benefits that are not available under Traditional Medicare (or “extras”) and are appealing and sometimes essential for low-income beneficiaries. Examples of these extras included transportation allowances, dental care, hearing aid coverage, and periodic financial assistance for utilities and groceries.
- None of the companies discussed their plans’ prior authorization requirements, any statistics regarding rates of coverage denial or appeals of non-coverage, or coverage of psychiatric care.
- Almost all the presenters touted increased dental benefits for 2024, indicating that consumers clearly want and respond to dental care benefits. This highlights the need for dental benefit reforms to Traditional Medicare to create parity with Medicare Advantage.
- Finally, every participating company touted “OTC” or “Extra Benefit” cards, with widely ranging values, but none of which exceeded a few hundred dollars a year. The cards, as noted by one presenter, could be used for any “non-ATF [alcohol, tobacco, firearms] items” at a wide range of grocery and value stores across the country.
Generally, the presenters – all marketers, salespeople, and a “growth manager” touted easy-to-provide “additional” benefits, while skimming over the more core coverages such as hospital stays, nursing home stays, outpatient care, and so on. We encourage beneficiaries to look carefully at all their coverage options during this Open Enrollment Period, which runs from October 15- December 7.
October 12, 2023 – M. Shepard, J. Lalor