Does Medicare Advantage have a COVID edge over fee-for-service?

Medicare Advantage beneficiaries were less likely to be hospitalized and die from COVID-19 during the first nine months of the pandemic compared with their fee-for-service counterparts, a new report finds.

From January to November 2020, individuals enrolled in the privatized Medicare plans made up 36% of hospitalizations among Medicare beneficiaries, despite representing 40% of eligible enrollees, according to a study released Thursday by research firm ATI Advisory.

Meanwhile, traditional, fee-for-service enrollees represented 64% of Medicare hospitalizations despite making up 60% of all eligible enrollees, according to the study, which is the third published analysis of how Medicare coverage influences COVID-19 outcomes and access to care. Half of all traditional Medicare members who were hospitalized with coronavirus were over 75-years-old, compared with 57% of Medicare Advantage members.

Those who were enrolled in traditional Medicare also had a higher mortality rate than those in Medicare Advantage. Twenty-two percent of fee-for-service beneficiaries hospitalized with coronavirus died during their visit, compared with 15% of Medicare Advantage enrollees.

The report relies on Medicare Current Beneficiary Survey data and is sponsored by Washington D.C.-based Better Medicare Alliance, a Medicare Advantage advocacy group supported by health insurers.

“Policymakers should explore what can be learned from Medicare Advantage as they work to improve the Medicare program more broadly,” said Allison Rizer, principal and lead researcher at ATI, in a news release.

Lower utilization among Medicare Advantage members compared with traditional Medicare is not new, however, with academic estimates ranging from 10% to 60%. A 2019 study in the American Economic Journal: Applied Economics, for example, found Medicare Advantage spending to be 30% lower per member per month than traditional Medicare.

Despite lower hospitalization and mortality rates, nearly twice as many Medicare Advantage beneficiaries, or 7%, who received a COVID-19 test reported a positive result, compared with 3% of fee-for-service members. The study said that members enrolled in both programs had equal access to testing services. But racial and ethnic minorities enrolled in Medicare Advantage were less likely to actually be tested.

Twenty-six percent of Black Medicare Advantage members had been tested for COVID-19 by November, compared with 30% of traditional members; and 24% of Latinx Medicare Advantage members had ever been tested, compared with 29% of fee-for-service Latinx individuals. Both groups contracted the virus at higher rates and were more likely to die from COVID-19 than whites.

Medicare Advantage members were also more likely to be hesitant to receive a COVID-19 vaccine, with 43% saying they felt reluctant getting inoculated compared with 40% of fee-for-service enrollees. The study was conducted before any of the COVID-19 vaccines were widely available.

While Medicare Advantage and traditional Medicare members reported the same likelihood of accessing care during the pandemic, Medicare Advantage members were more confident they could get diagnostics, access to dental care and receive treatment for an ongoing condition. Still, there is room for improvement among Medicare Advantage plans.

Fewer members enrolled in privatized Medicare actively managed their care in 2020, with just 55% managing their care last year, down nine percentage points from 2019, according to a recent study by data analytics firm J.D. Power. The J.D. Power study did not analyze how traditional Medicare members engaged with their providers.

For private insurers, engagement among dual-eligibles represented a bright spot, the ATI study said.

Among those who qualify for Medicare and Medicaid, 92% of dual-eligibles enrolled in Medicare Advantage plans reported access to urgent care, compared with 84% of fee-for-service enrollees; 78% said they could get diagnostics, compared with 66% of traditional beneficiaries; 68% of Medicare Advantage members received care for an ongoing condition, compared with 63% of fee-for-service; and 58% of Medicare Advantage members were confident in their ability to get a regular check-up, compared with 43% in traditional Medicare.

Although fewer Medicare Advantage beneficiaries had access to the internet during this time, the study said more of them accessed telehealth during the pandemic, particularly audio-only visits with their providers. Ninety-four percent of Medicare Advantage beneficiaries were able to access clinicians via audio appointments, compared with 87% of fee-for-service Medicare beneficiaries.

Health insurers and provider groups have been lobbying the Centers for Medicare and Medicaid Services for permanent coverage of audio-only telehealth, although the two disagree over how the service should be reimbursed. Both agree that, without coverage, broadband access represents a social determinant of health.

“This study shows that Medicare Advantage outperformed fee-for-service Medicare in access to non-COVID related care among dual-eligible beneficiaries, who are among the most at-risk members of the Medicare population,” Better Medicare Alliance CEO Mary Beth Donahue said in a news release. “This includes regular check-ups, urgent care, and treatment for ongoing conditions. While COVID-19 exposed shortcomings in many areas of health care, these findings tell a powerful story of how Medicare Advantage met the moment and saved human lives.”