Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts

Abstract

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007 to 2014, we compared beneficiaries' assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into an MA plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively, including, since 2010, quality bonus payments to these MA plans under provisions of the Affordable Care Act.

Medicare Advantage and Fee‐for‐Service Performance on Clinical Quality and Patient Experience Measures: Comparisons from Three Large States

“…While historically, FFS outperformed MA on measures of patient experience (Landon et al 2004;Keenan et al 2009;Mittler et al 2010), Elliott et al (2011) documented smaller differences between the two programs in 2007. Over the 8-year period beginning in 2007, both overall ratings of care and ratings of physicians were higher in MA, while ratings of specialists were comparable between the two systems (Elliott et al 2016).…”

“…Over the 8‐year period beginning in 2007, both overall ratings of care and ratings of physicians were higher in MA, while ratings of specialists were comparable between the two systems (Elliott et al. ).…”

Psychometric evaluation of the Medicare Advantage and prescription drug plan disenrollment reasons survey

“…A couple of limitations of this study should be considered when interpreting its findings, including the relatively low response rate and that there can be up to a 3‐month lag between when beneficiaries disenroll and when they complete the survey. The survey response rate is, however, typical for surveys of the Medicare population, and evidence suggests that response rate is typically not a good proxy for nonresponse bias . These limitations notwithstanding, our results indicate that the Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey provides a reliable and valid assessment of beneficiaries' reasons for disenrolling from MA‐PD plans and PDPs, information that, alongside information on plan disenrollment rates, can inform consumer choice and guide quality improvement.…”

“…A couple of limitations of this study should be considered when interpreting its findings, including the relatively low response rate and that there can be up to a 3-month lag between when beneficiaries disenroll and when they complete the survey. The survey response rate is, however, typical for surveys of the Medicare population, 27 and evidence suggests that response rate is typically not a good proxy for nonresponse bias. 28 Although prior approval and notification by CMS is not required, CMS was provided with an advanced copy of the manuscript as a courtesy.…”

Getting What We Pay For: How Do Risk‐Based Payments to Medicare Advantage Plans Compare with Alternative Measures of Beneficiary Health Risk?

“…), and MA enrollees report easier access to getting medications than those in stand‐alone plans (Elliot et al. ). This may arise because MA‐PDs have a much greater incentive to encourage compliance with drugs that help to reduce other forms of health care spending, such as hospitalizations and provider visits.…”