There’s no shortage of critics lining up to lambaste our nation’s health care system. And I’ll admit, I’ve often been first in line. But amidst the noise and rhetoric swirling over things like high-cost drugs and a lack of affordable coverage, one health care program is proving to be a huge success.
Medicare Advantage (MA) was created to offer seniors greater choice than Original Medicare, a government-run option that covers things like hospital care and doctor’s visits. MA plans are federally-funded but run by private health insurers – like CDPHP – and cover all the same benefits as Original Medicare, plus things like vision, dental, hearing, gym memberships, prescription drugs, and more.
Unlike traditional Medicare, Medicare Advantage plans are rewarded based on the quality of care they provide. As a result, MA plans are financially incentivized to keep their members healthy. And it’s working! A number of studies have shown that seniors covered under Medicare Advantage plans spent 19 percent fewer days in the hospital, had 28 percent fewer hospital readmissions, and 7 percent more primary care visits.
Here’s a few examples of how CDPHP members have benefitted from their Medicare Advantage coverage.
At 72 years old, Alan Lobel of Delmar says he’s in the best shape of his life. With his CDPHP Medicare Advantage plan, Alan has access to Silver Sneakers, a nationwide fitness benefit which allows him to work out at over 13,000 fitness centers across the country.
Alan hits the gym four to five days a week at the Albany Jewish Community Center, where he is particularly fond of the stationary Expresso Bike. He discovered the bike almost a decade ago and has since logged nearly 19,000 miles and burned over 825,000 calories.
69 year old George Knauer of Coxsackie enrolled in a CDPHP Medicare Advantage in 2015. Shortly after, he received a call from a CDPHP nurse, letting him know he was overdue for a colonoscopy. Knauer scheduled the test, which sure enough, revealed cancerous growths, called polyps. Thankfully, the polyps were removed before they could develop in full-blown cancer.
Knauer was so thankful for that call – and all the support he receives – that he insisted on meeting members of his CDPHP Care team. During the visit, he said to the group, “CDPHP is more than a health insurance company; it’s a health care company.”
During the final days of her dad’s life, Johna Palmer of Ravena learned first-hand the value of a CDPHP Medicare Advantage plan. At the time, her 83-year-old father, Gaetano “Guy” Anatriello, was in and out of the hospital, battling congestive heart failure and lung disease. That’s when Guy received a call from a CDPHP nurse, who told him he was eligible to receive in-home services through a partnership with Landmark Health. At first, Guy declined, but after discussing with his family, he decided to give it a try.
In the final days and months of Guy’s life, the Landmark team guided the family through many difficult decisions. Guy Anatriello passed away peacefully – in his home – on April 21, 2016. His loving family was by his side, as he wanted.
Speaking about the care her father received from the Landmark team, his daughter recalled, “You sat with my dad and our family for hours on end, never leaving us until you knew he was OK. Words cannot express what you have done for Dad, and for us, in our time of need.”
Because MA plans are more comprehensive than Original Medicare, most members pay a monthly premium without having to shell out extra cash for supplemental coverage. In fact, the average enrollee will pay just $28 per month next year, down about 6 percent from this year.
The combination of high-quality, cost-effective care has more and more seniors choosing Medicare Advantage over Original Medicare. In fact, more than 20 million Americans (34 percent) were enrolled in an MA plan in 2018. And, the Congressional Budget Office (CBO) projects that MA enrollment will to continue to grow over the next decade to 42 percent by 2028.
It’s tempting to want to point out the flaws in our system, but amidst all the negative news swirling in today’s society, we ought to be focusing on what is working. Perhaps, the success we’re experiencing with Medicare Advantage can provide us with the answers to fix our other ailing systems.
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