Medicare Advantage Members Have Fewer ER Visits Than Original Medicare

We’ve talked about Medicare Advantage plans recently, and how they compare with Original Medicare. In those articles, we’ve talked about the benefits of each, and how to decide which one is right for you.

Here’s a compelling reason for choosing Medicare advantage: you have a lower chance of hospitalization and emergency room visits.

Health research firm Avalere Health published an interesting study this month about Medicare Advantage results as compared to Original Medicare.

Take a look at the key points:

  •  Medicare Advantage plans have more members with disabilities and chronic health conditions compared to Original Medicare.
  • Medicare Advantage plan members have a 57 percent higher rate of serious mental illness and 16 percent higher rate of substance abuse than Original Medicare.
  • Despite the above, Medicare Advantage members had 23 percent fewer hospital stays and 33 percent fewer ER visits than members of Original Medicare.

Part of the reason for this is that Medicare Advantage encourages preventative services and tests that Medicare sometimes doesn’t even pay for. While the study found MA members paid slightly more than Original Medicare members, their health outcomes were significantly better.

The study also found that Medicare Advantage outperformed Original Medicare in key areas. Their rate of potentially avoidable hospitalizations was 29 percent lower than Original Medicare’s, their overall hospitalization rate was lower, and they had higher rates of medical screenings and tests.

The widest gap was in outcomes for diabetics with both high blood pressure and high cholesterol. Compared to Original Medicare, MA diabetics were half as likely to suffer complications. Their rate of serious complications was 73 percent lower as well.

Medicare Advantage accomplished this while keeping costs down—their spending average was 6 percent less than Original Medicare’s spending for members with the same conditions. In addition, member costs were 21 percent lower.

“Medicare Advantage plans’ focus on preventive care may help avoid downstream utilization of high-cost services driven by acute-care and emergency needs,” said Christie Teigland, vice president at Avalere.

While Medicare Advantage is not right for everyone, it’s clear that it offers some pretty big advantages for many of their members.

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