Medicare beneficiaries can elect to have their healthcare coverage administered either through traditional Medicare (also referred to as Original Medicare) or through private insurance plans. Medicare Advantage (MA), sometimes called Medicare Part C, is the program whereby beneficiaries can choose a Medicare-approved health insurance plan which is offered by a private company3.
Enrollment in Medicare programs continues to increase year by year – likely due to the aging population of the United States. While Original Medicare enrollment (Medicare Parts A and B) remains stagnant, MA plan enrollment has increased4. For 2018, enrollment in MA plans is projected to grow by 9%, and the Congressional Budget Office (CBO) anticipates that 41% of Medicare beneficiaries will be enrolled in MA plans by 20272.
Major payers are expanding in this market as it is considered to be quite stable2. According to a Kaiser Family Foundation analysis of 2017 data from the Centers for Medicare & Medicaid (CMS), eight payers (along with their affiliates) maintain more than three-fourths of the MA enrollees. Three payers, affiliates included, dominate the market with a share of roughly 57% of enrollees1,2.
For more than 15 years, GIRS has worked with each of these payers to educate them on our clients’ medical technologies, obtain favorable coverage and payment outcomes, and increased patient access. Our expertise in Medicare Advantage plan coverage gives our clients the support that they need for their products.
Are you a manufacturer of medical devices, pharmaceuticals, biologics, and/or diagnostics in need of expert support in overcoming barriers to Medicare Advantage plan coverage for your technology? Would you like to learn how GIRS can assist you with expanding coverage in Medicare markets? Contact us by email or call us at 1-844-514-4477.
Sources:
- https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/
- https://www.healthcaredive.com/news/why-payers-are-flocking-to-the-medicare-advantage-market/510589/
- https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html
- https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/index.html