Care Access, Coverage Value Similar in Medicare Advantage and Medicare

Coverage and care experiences were generally similar for Medicare Advantage and traditional Medicare beneficiaries, but instances of care delays and health assessments differed, a survey from the Commonwealth Fund found.

The Commonwealth Fund and its survey research partner SSRS conducted the survey between November 6, 2023, and January 4, 2024, gathering responses from 3,280 Medicare beneficiaries. They asked beneficiaries about the value of their care, measured by access to benefits, services, providers, care coordination, and satisfaction.

Beneficiaries in traditional Medicare (32 percent) and Medicare Advantage (33 percent) reported challenges accessing care during the past two years. Most beneficiaries said the issue occurred when trying to access primary care services. Between 16 and 18 percent of beneficiaries said they were told to go to urgent care as their provider had no available appointments.

Almost a quarter (22 percent) of Medicare Advantage beneficiaries said they had care delayed because it needed prior approval, compared to 13 percent of traditional Medicare beneficiaries. Medicare Advantage beneficiaries were also more likely to be unable to afford care because of copayments and deductibles (12 percent versus 7 percent).

People in Medicare Advantage plans were more likely to be asked to undergo a health assessment than those in traditional Medicare, the survey found. Health assessments gather information about beneficiaries’ health status, identify unmet care needs, or establish coordinated care management activities for chronic conditions.

Around 60 percent of Medicare Advantage beneficiaries said they were asked to undergo a health assessment—41 percent of whom had an assessment and 21 percent who did not. Meanwhile, just 27 percent of traditional Medicare beneficiaries were asked to undergo an assessment, with 23 percent having one and 4 percent not.

Medicare Advantage beneficiaries who had a health assessment were more likely to say the assessment led to a discussion with their doctor than traditional Medicare beneficiaries (62 percent versus 49 percent).

A small share of both Medicare Advantage and traditional Medicare beneficiaries said assessments were used to change care plans or offer additional benefits, but more beneficiaries said they were not clear on how the assessment was used.

While traditional Medicare beneficiaries tend to rely on physician offices and accountable care organizations (ACOs) to help with scheduling, Medicare Advantage plans often help their beneficiaries coordinate visits.

More than half of Medicare Advantage beneficiaries (55 percent) said their plan helped them schedule an annual visit to a primary care doctor. Beneficiaries also reported their plans helped schedule an eye exam or wellness screening (51 percent), an annual flu shot or COVID vaccination (48 percent), or a specialist appointment (45 percent).

The majority of Medicare Advantage beneficiaries (69 percent) used at least one of their plan’s supplemental benefits in the past year, while 31 percent did not use any supplemental benefits.

Beneficiaries in both Medicare Advantage and traditional Medicare are generally satisfied with their coverage. Sixty-five percent of beneficiaries said their coverage has fully met their expectations. For those who said their coverage has not fully met their expectations, common reasons were that their benefits did not cover what they needed, they were unsure of their benefits, and the costs were too high.

Among dual eligible beneficiaries, those in Medicare Advantage (62 percent) were more likely to say that their coverage fully met their expectations compared to those in traditional Medicare (45 percent).

Overall, access to benefits and services, as well as drawbacks, were similar across Medicare Advantage and traditional Medicare, suggesting that both programs have room to improve accessibility and affordability.