California has stark differences in senior health care when it comes to its northern and southern counties.
Across the country, Medicare Advantage has become increasingly popular among Medicare beneficiaries.
The privatized version of Medicare often sees insurers offer lower premiums, with vision and dental coverage added on. Altogether, more than 50 percent of eligible Medicare recipients are on the private plans, but a new report from health policy research firm KFF found drastic differences between Medicare Advantage enrollment in California regions.
The market penetration for Medicare Advantage was significantly lower in northern countries, while the southern parts of California often saw enrollment rates above 55 percent, data from the Centers for Medicare & Medicaid Services showed.
California differed from other populous states, such as Florida, which saw somewhat consistent percentages of Medicare-eligible residents on private plans.
Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, said California, specifically its northern region, has lagged behind other states in getting residents to submit all the documentation needed to register for these types of programs prior to deadlines.
“So many residents grew accustomed to having services either available fully for application online or extended with no paperwork required during the pandemic years and are failing to adjust to the new reality as quickly as many hoped they would,” Beene told Newsweek.
Medicare Advantage also occasionally struggles with its word-of-mouth advertising to those who are not yet participants, Beene added.
“California has had multiple situations of health care providers who failed to come to terms with Medicare Advantage and were subsequently dropped from those plans,” Beene said. “When you have a few situations like that, it’s easy to see why some frustrated recipients would discourage those they know from joining.”
More than a third of Medicare beneficiaries live in a county where at least 60 percent of all Medicare beneficiaries are enrolled in Advantage plans, KFF found. So on a wide scale, Medicare Advantage remains popular, but certain counties are often incentivized to stick with traditional Medicare.
“The wide variation in county enrollment rates reflect several factors, such as differences in firm strategy, urbanicity of the county, Medicare payment rates, number of Medicare beneficiaries, health care use patterns, and historical Medicare Advantage market penetration,” KFF said in its report.
Medicare Advantage beneficiaries made up more than half of all enrollees in 30 states, and seven states saw 60 percent or more of their Medicare recipients on privatized plans.
Typically, the counties that saw lower enrollment were rural, while urban areas saw a higher percentage opt into the privatized version of Medicare.
Part of this may be due to the limited networks people on Advantage plans often have to deal with, and in rural areas, there could be a lower number of health care providers who accept a specific Medicare Advantage plan.
There are other notable cons in some cases to taking on a Medicare Advantage plan. Many insurer plans require doctors and hospitals to get approval for treatments in a “prior authorization” request, which can take weeks or even months.
“Medicare Advantage plans claim to use prior authorizations to manage costs and reduce unnecessary medical services,” Smile Insurance CEO Chris Fong told Newsweek. “However, prior authorizations are viewed by many medical providers and patients as an unnecessary barrier to care.”
KFF also found that the number of prior authorization requests denied by Medicare Advantage grew between 2021 and 2022, from 5.8 to 7.4 percent. Altogether, KFF said, 3.4 million prior authorization requests were denied.