March 02, 2016 Healthy Living

Why We Must Protect Medicare Advantage

It’s a story that affects tens of thousands of low-income seniors here in the Capital Region, but rarely gets the coverage it deserves. That is, the ongoing war over federal funding and policies in support of the Medicare Advantage (MA) program.

Medicare Advantage was created in 2004. Since then, 17 million seniors and individuals with disabilities, including 67,000 Capital Region residents, have signed up for this innovative program. Medicare Advantage has become more attractive to seniors in recent years, mainly because the health plans are more generous than traditional Medicare and are required to cap a member’s out-of-pocket expenses.

Unlike traditional Medicare, Medicare Advantage plans are rewarded based on the quality of care they provide. As a result, Medicare Advantage plans are encouraged to keep their members healthy, keep them out of the hospital, and coordinate their care. In fact, 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 seven percent more primary care visits. In addition, Medicare Advantage plans have outperformed traditional Medicare on a number of health measures, including breast cancer screenings, diabetes care, and cholesterol testing for cardiovascular disease.

What’s more important? Seniors are happy with Medicare Advantage. According to The Coalition for Medicare Choices, 94 percent of seniors who have a Medicare Advantage plan are satisfied with the quality of care they receive.

why medicare advantage matters

Despite these many successes, federal policies often work against Medicare Advantage. The Affordable Care Act – which has used the Medicare Advantage program as a funding mechanism – has imposed new taxes and cut reimbursements for Medicare Advantage, forcing many plans to increase premiums and reduce benefits, disproportionately hurting millions of low-income seniors, as more than 40 percent of Medicare Advantage enrollees earn less than $20,000 per year.

Last month, a bipartisan group of more than 360 lawmakers – led by Senator Chuck Schumer (D-NY) and Senator Mike Crapo (R-ID) – sent letters to the Centers for Medicare & Medicaid Services (CMS), urging the agency to protect the millions of seniors who have come to depend on these plans. According to Schumer, “Annual payment and policy changes create disruption and confusion among beneficiaries, especially in low income, rural, and minority populations. Additional cuts have the potential to stifle innovation and further impede beneficiary access to high quality health care.” Senator Crapo went on to say, “The administration’s repeated attempts to use the MA program as a piggybank to offset inefficiencies in Obamacare and traditional Medicare undermines the future stability of the program.”

We can all agree that the health care system needs some financial restructuring, but this cannot be done on the backs of senior citizens who have paid their dues. In the coming weeks, I would encourage policymakers to take a closer look at the value proposition offered by Medicare Advantage plans and how it affects the millions of people who are depending on this program.

John D. Bennett, MD, FACC, FACP
About the Author

John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.

2 Responses to “Why We Must Protect Medicare Advantage”

  1. Philip W. Klein

    As a Senior and a Medicare Advantage card holder I can not stress enough the advantages of this program. I have been selling Group Health Insurance for over 40 years and can attest to the quality that this program and the benefits it brings to Seniors. Please make every effort to maintain this excellent program. Thank you,

Get our favorite local activities, health tips
and more, each month.