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What goes up must come down.
After years of aggressive expansion, many Medicare Advantage plans are trimming or recalibrating popular extras like dental, vision and over-the-counter allowances. The reason is tighter reimbursement rates, rising healthcare utilization and mounting margin pressure, said Cristin Hopkin Bishop, chief operating officer at The Brokerage, whose field marketing organization works with major insurance carriers across the US. These forces are fundamentally changing how Medicare Advantage plans are structured and priced, meaning financial advisors working with retirees should take note.
“The current environment is forcing plans to rebalance benefits,” Hopkin Bishop told Retirement Upside. “Are higher out-of-pocket costs inevitable? Not necessarily across the board, but some level of cost-sharing adjustment is likely going to happen.”
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Traditional Medicare requires beneficiaries to piece together multiple products, including Part A, Part B, a Part D drug plan, and often a Medigap policy. Medicare Advantage combines those elements into a single plan, which is easier for many beneficiaries to understand and manage. Further, traditional Medicare does not have an annual out-of-pocket maximum. Medicare Advantage plans do, which gives retirees a clearer ceiling on what they could spend in a year.
With tighter margins, carriers are also concentrating on markets where they can operate sustainably and deliver strong provider networks. In some cases, they’re exiting counties where the economics or provider dynamics no longer make sense. Plans have several levers they can pull before raising member costs, including:
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Adjusting supplemental benefit levels.
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Refining provider networks.
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Modifying prior authorization or care management programs.
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Redesigning copay structures rather than premiums.
“Bottom line, the Medicare Advantage market is maturing,” Hopkin Bishop said. “The last decade was largely about expansion and benefit growth. The challenge for carriers now is maintaining that value while adapting to a more constrained economic environment.”
Why Medicare Advantage Expanded So Aggressively. Medicare Advantage plans are also allowed to offer expanded benefits such as dental, vision, hearing, transportation, fitness programs, additional food or grocery shopping cards, and some in-home support services, which has been a boon for the programs.
