A Review of Medicare Advantage Policy Through the Lens of Geriatrics and Palliative Care

Purpose of Review: Medicare Advantage (MA), or Medicare Part C, is the program that allows private health insurance companies to provide Medicare services. MA is growing exponentially with increasing enrollment of older adults who are more medically and socially complex and more racially and ethnically diverse. Legislative and regulatory oversight of MA has lagged behind its growth. Here we review key aspects of MA pertinent to older adults and those with serious illness, and we highlight recent major federal policies shaping MA. Recent Findings: While MA was initially developed to provide cost savings, generate innovations in care, and improve healthcare quality, data indicate that costs are higher and quality is variable as compared to traditional Medicare. Development of functional impairment or worsening illness are associated with people switching from MA to traditional Medicare, which raises concerns about whether MA can adequately meet the needs of complex older adults. Recent legislative and regulatory updates have allowed MA plans to expand supplemental benefits that target social determinants of health and offer access to palliative care. Regulations continue to work towards increased transparency around quality and marketing of MA plans. Summary: MA has the potential to be beneficial for older adults and those with serious illness, but there remain challenges for those with increasing social and medical complexity. Now that 50% of older adults will have insurance coverage through MA, there is great need for thoughtful, patient-centered federal policies for MA to ensure quality care for older adults, especially the most vulnerable. Clinicians, educators, and researchers need to be aware of how MA works, its implications for older adults, and how the latest federal policy changes to MA will affect the practice of medicine and what care their patients can access.