A Review of 62 Studies Finds Few Big Differences Between Traditional Medicare and Medicare Advantage on a Variety of Measures

With the Medicare open enrollment interval set to start Oct. 15, a perennial choice confronted by Medicare beneficiaries is whether or not to get their protection by means of conventional Medicare or the non-public plans referred to as Medicare Benefit.

A brand new KFF evaluate of 62 research printed since 2016 that compares Medicare Benefit and conventional Medicare on measures of beneficiary expertise, affordability, utilization, and high quality finds few variations which can be supported by robust proof or have been replicated throughout a number of research. For instance, beneficiaries in each protection varieties reported comparable charges of satisfaction with their care and total measures of care coordination.

Notably, comparatively few research particularly examined particular subgroups of curiosity, comparable to beneficiaries from communities of shade, dwelling in rural areas, or dually eligible for Medicare and Medicaid, making it troublesome to evaluate the power of the findings or how broadly they apply.

In some areas, nevertheless, the analysis recognized noteworthy variations between Medicare Benefit and conventional Medicare, together with: 

Medicare Benefit:

  • Medicare Benefit enrollees have been extra seemingly than these in conventional Medicare to report having a common supply of care. They have been additionally extra more likely to obtain preventive care companies, comparable to annual wellness visits and routine checkups, screenings, and flu or pneumococcal vaccines.
  • Medicare Benefit enrollees reported higher experiences getting wanted prescribed drugs than conventional Medicare beneficiaries total. Nonetheless, amongst beneficiaries with diabetes, most cancers, or a psychological well being situation, findings have been blended.
  • Most research discovered that utilization of residence well being companies and post-acute expert nursing or inpatient rehabilitation facility care was decrease amongst Medicare Benefit enrollees than conventional Medicare beneficiaries, however have been inconclusive as as to if that was related to higher or worse outcomes.

Conventional Medicare:

  • A considerably smaller share of conventional Medicare beneficiaries than Medicare Benefit enrollees skilled a cost-related downside, primarily attributable to decrease charges of cost-related issues amongst conventional Medicare beneficiaries with supplemental protection. (However conventional Medicare beneficiaries with out supplemental protection had essentially the most affordability-related difficulties.)
  • Conventional Medicare outperformed Medicare Benefit on measures comparable to receiving care within the highest-rated hospitals for most cancers care or within the highest-quality expert nursing amenities and residential well being companies.

In different areas, although, findings have been blended or confirmed little distinction between Medicare Benefit and conventional Medicare primarily based on a number of research.

Among the many findings:

  • There have been usually no variations within the combination variety of hospital days or common size of keep for frequent medical admissions.
  • Neither Medicare Benefit nor conventional Medicare persistently carried out higher throughout all high quality measures.
  • Moreover, two analyses of a number of measures of beneficiary expertise discovered no variations between the 2 teams in experiences with wait occasions and within the share reporting hassle discovering a basic physician, being instructed that their medical health insurance was not accepted, and being instructed they might not be accepted as a brand new affected person.

Findings associated to the usage of different well being care companies, together with hospital care and prescribed drugs, and condition-specific high quality of care measures different – seemingly attributable to variations in information and methodology throughout research.

Curiosity in how effectively Medicare Benefit plans serve their rising and more and more numerous enrollee inhabitants has by no means been increased, as Medicare Benefit, for the primary time, is projected to enroll greater than half of all eligible Medicare beneficiaries subsequent 12 months, making it the principle means that Medicare beneficiaries get their protection and care. Compared, simply over a decade in the past in 2010, 25 p.c of the eligible inhabitants was in a Medicare Benefit plan.

The Medicare open enrollment interval runs by means of Dec. 7.

The total evaluation, Beneficiary Expertise, Affordability, Utilization, and High quality in Medicare Benefit and Conventional Medicare: A Assessment of the Literature, in addition to extra information and analyses about Medicare Benefit, can be found at

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