“The market is highly volatile right now,” she told Becker’s. “If Medicare Advantage provides significant benefits and is a true financial necessity, then that’s the path you should take. However, if you can afford to wait, it may be wise to sit this year out and observe how things unfold.”
Ms. Mays is the founder and CEO of Copeland Road Health Ventures, an advisory firm for health plans and providers. She previously served as EVP of healthcare delivery at Capital Blue Cross, SVP and COO at UnitedHealthcare’s PreferredOne, president of North American medical management at Optum, and COO at Chapel Hill, N.C.-based UNC Health.
“I’m not saying never do it in the future, but this year seems to be the perfect storm,” she said. “If you can wait, you’ll have a clearer view of what the market will look like moving forward. Yes, there are added benefits, but it’s unclear what those benefits entail right now.”
When the Medicare annual enrollment period begins in mid-October, there will be significant changes for many older adults and health plans across the country, including shifts in plan quality, increased contract disputes, and market exits from some large carriers. The uncertainty is being fueled by increased government scrutiny of the MA program, tighter CMS regulations, reduced base payments, and rising healthcare costs among seniors.
“There’s also a reduction in supplemental benefits, and people will begin to notice those differences,” Ms. Mays said. “For seniors who expect benefits like transportation, grocery allowances, or Meals on Wheels, those may no longer be included in some plans.”
“We’ll also see how providers align with plans, and there may be further narrowing of Medicare Advantage networks in certain markets, which we’ve already begun to witness. Everyone in this space is trying to figure out their position right now,” she added.
Medicare Advantage now provides health coverage to 33.8 million people, or about 55% of the total Medicare population. Throughout 2024, some hospitals and health systems have been paring down their MA contracts, looking for payer partners that align better with their financial objectives.
“I expect we’ll continue to see this, giving people a better idea of whether their preferred plan and health system will remain connected,” Ms. Mays said. “The rules around entering and exiting plans could be tightened, and communication with seniors about these changes should improve. Leaving it to plans to inform seniors that, ‘By the way, we’re no longer offering your plan, find another,’ is insufficient. CMS could better coordinate these communications and provide more information on plan changes, entries, and exits.”
Medicare’s annual enrollment period starts Oct. 15 and runs through Dec. 7. During this time, Medicare beneficiaries can make changes to their Medicare Advantage plans, switch between traditional Medicare and MA, or alter their Part D prescription drug coverage. The changes made during the period will take effect on Jan. 1, 2025.
