Study Highlights Elevated Administrative and Financial Burdens in Medicare Advantage for Patients with Multiple Chronic Conditions
A 2022 cross-sectional analysis of the Health and Retirement Study Treatment Burden Questionnaire module examined treatment burdens among 1,024 Medicare beneficiaries aged 65 and older, split nearly evenly between traditional Medicare (TM) and Medicare Advantage (MA) enrollees.
The study focused on four treatment burden dimensions: frequency and time related to doctor visits, administrative burdens including paperwork and prior authorizations, difficulty in relationships with providers, and financial burdens from out-of-pocket expenses. Most Medicare beneficiaries reported low treatment burdens overall. However, administrative and financial burdens were significantly higher among those with six or more chronic conditions, with 24.3% of MA enrollees and 15.0% of TM beneficiaries experiencing high administrative burdens.
Similarly, 27.7% of MA enrollees with multiple chronic illnesses reported high financial burdens, compared to 15.0% of TM counterparts. The study noted that administrative burdens are likely driven by managed care practices in MA plans, such as prior authorization requirements, which can increase patient workload and delay care. Although MA plans generally offer lower premiums and out-of-pocket caps, the need for prior authorization and possible claim denials may increase out-of-pocket spending, especially for complex cases involving multiple specialists and services. Treatment burden related to doctor visits and provider relationships remained low overall but increased modestly with the number of chronic illnesses. The research observed disparities in treatment burden by education level and race/ethnicity, with those having lower education and Black or Hispanic beneficiaries generally facing higher burdens regardless of Medicare plan type. The findings suggest that while MA offers certain cost containment benefits, the administrative complexities may add significant burden to sicker beneficiaries. The study underscores the need for regulatory oversight aimed at reducing administrative hurdles and financial challenges for vulnerable Medicare populations.
Limitations include reliance on self-reported data, small sample size, and lack of data on out-of-network visits. The 2022 Inflation Reduction Act's drug out-of-pocket cap starting in 2025 addresses some cost concerns but does not fully alleviate overall financial burdens faced by Medicare beneficiaries. These insights are relevant for policymakers and insurers seeking to balance cost control with patient-centered care in Medicare programs.