Medicare-eligible seniors in Maryland suffer from a limited number of health insurance benefit options compared to other states. While the share of Medicare beneficiaries enrolled in Medicare Advantage plans climbed to almost 40% nationally in 2020, in Maryland only 13% of seniors enjoy the added security these plans provide.
Thankfully, efforts by local leaders as well as the Biden administration can help our state’s seniors by improving access to coverage choices and supplemental benefits not otherwise covered under traditional Medicare.
Five years ago, I took the position of a local chapter president for the NFL Alumni Association. Our mission at the association is threefold, “Caring for Kids, Caring for Our Own and Caring for the Community.”
As I looked into the demographics of our members, I noticed the large percentage of former players 65+ living in all parts of our state, who are eligible for Medicare coverage. It may be surprising to some people to hear that a large percentage of these members live in the low-mid income status.
Even though these are the men who helped build the NFL today, they don’t have a special retirement package that many may think they have. Just like all seniors, this population of NFL retirees living in Maryland are adversely affected by limited choice for Medicare options. My passion for our members and the general public is to “Care for Our Community” and help live a more healthy aging life.
Based on data from the Centers for Medicare & Medicaid Services, the share of Medicare beneficiaries enrolled in Medicare Advantage doubled over the past decade. Yet in addition to Maryland seniors enrolling in this benefit at one-third of the national rate, there were six counties with no Medicare Advantage plan options, and another six counties with only one option. And as Medicare Advantage plans are projected to safeguard over 50% of seniors nationally by 2030, Maryland is going the other direction, with several plans exiting the market in recent years.
The Biden administration and local leaders can implement a series of straightforward changes that the previous administration did not address. The fix must begin with a simplified understanding on the part of CMS that there is a reason why Maryland’s seniors have been denied access to enhanced health insurance options that citizens in so many other states enjoy.
Essentially, Maryland has a unique heath care payment system for its hospitals. But the methodology used by CMS to establish premium revenue for Medicare Advantage plans in Maryland does not take into account our one-of-a-kind Total Cost of Care Model for hospital payments.
This results in uneconomic premiums for Maryland Medicare Advantage plans compared to many other states. The result, of course, is a market which does not allow these plans for seniors to operate in a financially viable manner and, unfortunately, Maryland’s beneficiaries pay the price.
While enrollment in a Medicare Advantage plan isn’t for everyone, such plans typically provide supplemental benefits and coverage options not offered by traditional Medicare, supporting the requirements of seniors with specific health care needs and/or chronic conditions. Depending on the plan, such benefits can include eye exams and glasses, dental benefits, hearing aids, meal benefits, over the counter benefits, fitness benefits, transportation to and from appointments, and other benefits that beneficiaries covered under traditional Medicare do not enjoy.
Further, for individuals who take medications, Medicare Advantage plans may provide improved drug coverage compared to the standard Medicare Part D prescription drug benefit, which includes a deductible and a coverage gap phase.
In my company, Caring One, we work with health care providers to improve patient outcomes and communications. Preventive care is critical to our work, often reaching out to high-risk patients to ensure proactive intervention. I know first-hand that adequate insurance coverage, such as Medicare Advantage plans, help ensure that Maryland’s seniors are not basing care decisions on when a Social Security check may be arriving, but on what is best for their health.
Additionally, given the challenging premium allocation for Maryland Medicare Advantage plans, the benefits are not as complete or as consumer friendly as in other states.
For example, an analysis of benefits offered by the same insurer in Maryland, Delaware and Pennsylvania reveals that the seniors with Medicare Advantage plans have more comprehensive coverage in those other states, which enjoy a lower monthly premium for the beneficiary, lower maximum out-of-pocket costs, lower hospital costs per day, lower specialist copayment, higher dental and vision coverage, higher number of allowable transportation trips and higher over the counter coverage.
Maryland is worse on all of these measures.
The Biden administration can help Maryland’s seniors by recognizing the reality of our health care payment system. Under our system, Maryland’s providers do a great deal to contain costs while simultaneously improving quality.
The federal government should continue to incentivize this innovation.
But our success should not come at our seniors’ expense. It doesn’t have to if the administration acts to support effective Medicare Advantage plans, thereby “Caring for Our Own and Caring for Our Community.”
The writer is president of Caring One, president of the National Football League Alumni Baltimore Chapter and a board member of the NFL Alumni Association.