Group Medicare Advantage plans face challenges amid growth

“If patients ask me about a general [individual] Medicare Advantage plan, I can go into Plan Finder and get all the details. We all have access to that information,” Hoadley said. “But if I’m working with a retiree group waiver plan, then I’m limited to whatever that employer provides the retiree.”

Employers switching retirees to Medicare Advantage plans should offer a grace period during which patients can continue seeing their existing doctors—if the doctors will eventually be dropped from the plan—and communicate about how the plan is expected to change over time, Hoadley said. Many employers initially offer generous out-of-network coverage to try and sell the plan to patients, but don’t sustain the benefit over time, he said.

Employers should also explain to retirees how they can opt out of their group Medicare Advantage plan and enroll in traditional Medicare or other forms of coverage, he said. They should clarify if an individual will be subject to different enrollment deadlines, or penalized for choosing an independent plan.

“Companies that communicate the changes well tend to have less pushback. But if the communication doesn’t work so well, or if the changes are more dramatic—let’s suppose a limited-network HMO was the only option—it’s quite likely you’re gonna get some pushback,” Hoadley said.

Any reimbursement and policy changes to the Medicare Advantage program could slow adoption too, Hoo said. CMS is weighing several moves that could increase costs for Medicare Advantage plans, possibly decreasing insurance companies’ momentum and savings for employers. The agency in December proposed cracking down on and automating Medicare Advantage carriers’ use of prior authorization and refining their quality ratings system. The agency also said it will finalize a long-awaited rule by February about how federal payments to private Medicare carriers should be audited.

Despite these obstacles, Hoo said she views the future of group Medicare Advantage as bright, as employers increasingly look to save on retirees’ healthcare costs.

“It’s still very strong,” she said.