Medicare Advantage is becoming the dominant option for Medicare coverage. Congress must increase transparency about programmatic costs and benefits to encourage beneficiary choice.
Transparency has been defined as "the quality or state of being transparent; the action or process of making something clear, open, and comprehensible to the mind." In healthcare, transparency is essential to ensure that consumers have access to the information they need to make informed decisions about their care.
When it comes to Medicare, there are two primary areas in which transparency is critical: A patient's cost-sharing obligations and how much Medicare will pay a provider for services rendered. The former is important because it gives patients an idea of their out-of-pocket costs for a given medical service. The latter helps patients evaluate whether or not a doctor or other health care provider is likely to provide high-quality care at an affordable price.
Both beneficiaries and policymakers will need to be able to make accurate and meaningful comparisons between Medicare Advantage and traditional fee-for-service Medicare as Medicare Advantage becomes more dominant.
Recent debates among policy experts, government advisory boards, and health plans have highlighted the need for a standardized comparison between the two Medicare programs. A series of structured comparisons should be used to evaluate Supplemental benefits, Medicare Part B cost-sharing differences, and prescription drug benefits.
This information should be made transparent to beneficiaries via the plan finder. It will improve beneficiary decision-making. Finally, policymakers would benefit from pragmatic comparisons to improve Medicare Advantage program policy, conduct comparative program evaluation, or engage in Medigap program oversight.
Both beneficiaries and policymakers will find it increasingly important to compare Medicare Advantage (MA), the dominant Medicare coverage option, with a clear comparison to traditional fee-for-service (FFS).
- FFS beneficiaries should be included in the comparative population if they are eligible for MA.
- To empower beneficiaries' choice, beneficiary cost-sharing differences and supplemental benefits should be clearly and transparently valued.
- Structured comparisons between MA Medicare and FFS Medicare would encourage comparative program evaluation. This would facilitate future improvements in MA benchmark policies and Medigap plan oversight.
The Medicare program has been hailed as one of the most successful government programs ever created. However, there is still room for improvement in several key areas. In particular, Medicare needs to improve its transparency regarding cost information for consumers shopping for private insurance plans or switching between options such as Medigap supplemental plans or Medicare Advantage plans (also known as Part C).