A panel of leading health care voices and passionate advocates of Medicare Advantage (MA) this week invited members of Congress and their staff to participate in a powerful health coverage discussion. They stressed why Medicare Advantage is the preferred coverage option for more than 33 million seniors and people with disabilities, and how lawmakers can protect the program.
Here are the top snippets you missed.
Sandy Smith, Michigan, Age 72
“I had a knee replacement, but with Medicare Advantage, it took care of all my physical therapy. I didn't have to worry about ‘how am I going to afford to take care of this and continue to do what I like to do best?' And that’s to dance. That was the first thing I asked the doctor: 'Can I dance again?' But with the physical therapy that was provided with the help of MA, I was able to start dancing again.”
“I really hope that [lawmakers] do not mess with Medicare Advantage, because there's a lot of seniors out here like me that need it. It would be a catastrophe if they were to do something with that, so please preserve and keep Medicare Advantage so I can keep dancing.”
Bill Wong, Nevada, Age 71
“Knowing that I was in the hospital and expecting very high bills, I was very pleasantly surprised that it was very minimal. A lot of things were covered under MA, which I didn't know… I'm fully back to where I can travel and can spend time with my kids.”
“My mother just turned 99 last week, and I'm hoping to live that long... but me and my two older brothers, we are diabetic. And I’ve known for years how much the cost is for my medication… my insulin. Since I signed up with MA, my costs — I usually was around at least $400 a month on medication — it has dropped by a third since I started with MA and I really appreciate that.”
Dr. Yanira Cruz, President and CEO of the National Hispanic Council on Aging
“It is imperative to recognize that a significant majority of Latino Medicare recipients actively choose Medicare Advantage over traditional fee-for-service Medicare… What sets Medicare Advantage apart is its ability to cater to the unique needs of diverse communities, especially those facing social, economic, and environmental challenges.”
Mark Hamelburg, Senior Vice President of Federal Programs, AHIP
“The structure of Medicare Advantage is designed to encourage plans to partner with providers and deliver care more efficiently… when they do that, they can offer more affordable coverage and additional benefits that their enrollees value.”
“In 2024, Medicare Advantage plans bid, meaning they said they could deliver, the cost of the benefit at 82% of fee-for-service costs. That's 18 percentage points below the cost that the fee-for-service program is costing to deliver that same benefit. Because of this, plans have been able to offer a variety of reduced cost-sharing and additional benefits to enrollees.”
“In case anyone is wondering whether the affordability and efficiency I was talking about is at the expense of care, there are numerous studies and clinical quality measures that demonstrate that the affordable coverage is being achieved by improving care — whether it's reduced hospital admissions, fewer preventable inpatient admissions, [or] lower rates of inappropriate medication use.”
Jennifer Podulka, Vice President of Federal Policy for America's Physician Groups
“Our motto is ‘taking responsibility for America's health,’ and it underscores our physician groups’ preference for being in risk-based, accountable, and responsible relationships with all payers, including Medicare Advantage health plans, rather than being paid on a fee-for-service basis. Because this alternative, fee for service is really not optimal for patients or for physicians. MEDPAC and others have raised concerns that fee for service rewards volume, or just the number of services provided rather than the value of those services or their quality for patients. It's particularly ill-suited for primary care and for the sort of longitudinal care that's needed for people's chronic conditions.”
“Here's the key difference between value-based care arrangements under Medicare Advantage and fee for service: under value-based care, physicians who have accepted responsibility for the quality and total cost of care for the patients that they see work to develop, constantly refine, and implement a care plan for their patients. They invest their time and their care team’s time into that care plan.”
“Ongoing physician and care team management of patients’ health and social needs is supported in value-based care with Medicare Advantage plans in ways that just aren't possible for physicians in fee for service.”
Michelle Soper, Vice President, Federal Policy & Advocacy for Commonwealth Care Alliance
“Nearly half of our members have 4 or more chronic conditions. Fifty percent of those individuals have diabetes. We also serve a very diverse population where more than half of our memberships speak languages other than English.... We really do have the ability as a Medicare Advantage plan, an integrated Medicare Advantage plan, to improve access for all and to be able to coordinate across the many providers and social services and community-based partners that our members need.”
“The premium supports that supplemental benefits can provide are so fundamental to our members who might not be eligible for Medicaid — so are not enrolled in our duals plan but are still in low-income brackets — and cost sharing can be budgeted for food or utilities or other extremely important services.”
“Our ability as a Medicare Advantage plan to partner with our communities — partner and foster innovation in a way that we wouldn't be able to do so without this platform — [these] really successful partnerships in the community are driven by identified gaps in care among covered services.”
Click here to read more research and top stats on the benefits of Medicare Advantage.