The Average Medicare Beneficiary Has a Choice of 43 Medicare Advantage Plans and 24 Part D Stand-Alone Plans for Coverage in 2023

For 2023, the typical beneficiary has a choice of 43 Medicare Advantage plans as an alternative to traditional Medicare, a new KFF analysis finds. That’s an increase of 5 plans on average from 2022, adding even more choices to the Medicare Advantage marketplace, which is poised to become the dominant way Medicare beneficiaries get their health coverage and care.

In addition, the typical beneficiary has a choice of 24 Medicare Part D stand-alone prescription drug plans for 2023, a second KFF analysis finds, one more than in 2022.

These findings are featured in two briefs released by KFF today that provide an overview of the Medicare Advantage and Medicare Part D marketplace for 2023, including the latest data and key trends. Medicare’s open enrollment period began Oct. 15 and runs through Dec. 7.

Medicare Advantage

More than 28 million Medicare beneficiaries – 48 percent of all eligible beneficiaries – are enrolled in Medicare Advantage plans, which are mostly HMOs and PPOs offered by private insurers. Enrollment is projected to cross the 50 percent threshold as soon as next year.

For 2023, a typical beneficiary has 43 Medicare Advantage plans to choose from in their local market, including 35 plans that offer Part D drug coverage. In total, 3,998 Medicare Advantage plans will be available across the country.

Read the full article from KFF.

People With Long Covid Face Barriers to Government Disability Benefits

When Josephine Cabrera Taveras was infected with covid-19 in spring 2020, she didn’t anticipate that the virus would knock her out of work for two years and put her family at risk for eviction.

Taveras, a mother of two in Brooklyn, New York, said her bout with long covid has meant dealing with debilitating symptoms, ranging from breathing difficulties to arthritis, that have prevented her from returning to her job as a nanny. Unable to work — and without access to Social Security Disability Insurance or other government help — Taveras and her family face a looming pile of bills.

“We are in the midst of possibly losing our apartment because we’re behind on rent,” said Taveras, 32. Her application for Social Security disability assistance, submitted last fall, was rejected, but she is appealing.

Like many others with long covid, Taveras has fallen through the cracks of a system that was time-consuming and difficult to navigate even before the covid pandemic. People are facing years-long wait times, insufficient legal support, and a lack of clear guidance on how to prove they are disabled — compounded by the challenges of a medical system that does not have a uniform process for diagnosing long covid, according to health experts and disability attorneys.

The Biden administration promised support to people with long covid, but patient advocates say many are struggling to get government help.

The Centers for Disease Control and Prevention defines long covid broadly, as a “range of ongoing health problems” that can last “weeks, months, or longer.” This description includes people, like Taveras, who cannot work, as well as people with less severe symptoms, such as a long-term loss of smell.

Read the full article from KHN.

Pediatric Shared Decision-Making: Creating Better Communication for Your Child’s Care

Shared decision-making (SDM) is a set of processes where health care decisions are made through respectful collaboration between doctors, patients, and their parents or guardians. The American Academy of Pediatrics (AAP) and many other medical care groups see SDM as a key part of family-centered care. However, SDM may not be used as often as it should be. There are many reasons for this, such as:

  • Doctors have not learned how to do SDM.
  • There is not enough time.
  • There can be an imbalance of power between the medical care team and the family.
  • There is an existing lack of understanding of what SDM is and how to participate in SDM.

In this month’s Pediatrics, “Pediatric Shared Decision-Making for Simple and Complex Decisions: Findings from a Delphi Panel”, Eaton et al (10.1542/peds.2022-057978) explore the SDM process to look at what SDM is and how it is best implemented.

What did the authors find in the study?
The processes of SDM refer to the activities, in the short and long term, involved in making decisions. For example, an initial process could be to:

  • Establish a relationship with the family
  • Discuss research treatment options
  • Ask if the family understands the clinical issue and the decision that needs to be made.

The main findings of the study show the need to personalize this decision-making process to each family’s unique situation and preferences. Examples of ways to personalize the process can include:

  • Determine information preferences- such as language, amount, type, method and with whom the information is to be shared. For example, how can the information be given in a way that is accessible, useful, and meaningful to the family?
  • Discuss the role of the child and parent/guardian in the SDM process. For example, does the child want to be a part of the process? Are they old enough? Are they mature enough?
  • Explore family values and what matters most to them. For example, is a family willing to discuss these topics with the rest of the care team and/or with the child?
  • Discuss guidance from the medical team about the child’s care. For example, what type of information does the family want from the doctors and nurses providing the care?

The authors introduce a framework that suggests different ways to help with the SDM process. Developed based on learnings from the study, the framework aims to provide a range of strategies to help personalize the process to unique needs of the child, family and clinical situation. The framework provides guidance to be used in all types of decisions, as well as additional guidance for more complex decisions.

The study also highlights areas where the panel did not agree. For example, the panel did not agree on topics such as:

  • Should “personalized” or another word replace “shared” in this process?
  • How do you decide what the child’s role in the process should be?
  • Should a family be asked if they want a recommendation before a doctor gives one?

The full article is available from the American Academy of Pediatrics.

Updated COVID-19 booster eligibility expanded to people ages 5 and older

The Washington State Department of Health (DOH) and other healthcare providers will soon begin offering Omicron variant-targeted bivalent booster doses of COVID-19 vaccines to people ages 5 and older, following guidance and recommendations from the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the Western States Scientific Safety Review Workgroup.

“This is another step forward to a healthier tomorrow for everyone in Washington state,” said Umair A. Shah, MD, MPH, Secretary of Health. “The more people who are eligible for COVID-19 boosters, the better protection we can provide to our communities.

This new demographic of booster eligibility expansion follows last month’s rollout of the updated (bivalent) COVID-19 vaccine, which specifically targets the BA.4 and BA.5 subvariants that currently make up the majority of COVID-19 cases across the country. The Department of Health urges all individuals 5 and older to prioritize receiving the updated booster as we enter the beginning of cold and flu season. Additionally, flu vaccines are now available at many provider offices and pharmacies across the state and are safe to receive concurrently with the COVID-19 bivalent booster.

“It’s also time to get your flu shot,” Dr. Shah added. “We are entering respiratory illness seasons and it is a critical time to protect yourself and those around you from influenza.”

DOH’s updated COVID-19 booster dose recommendations are as follows:

  • People ages 5 and older who have completed a primary vaccine can receive the Pfizer-BioNTech bivalent booster at least two months after their most recent dose. These doses are scheduled to begin arriving in provider offices the week of October 17th.
  • People ages 6 and older who have completed a primary vaccine series can receive the Moderna bivalent booster at least two months after their most recent dose. Providers who already have an inventory of Moderna can begin administering these doses immediately.
  • Children ages 6 months to 4 years remain eligible for the primary, monovalent COVID-19 vaccine series from both Pfizer-BioNTech and Moderna and are not currently authorized for any COVID-19 booster doses.

As with previous vaccine and booster rollouts, the CDC will provide states with weekly allocations, building each state’s inventory levels over time. DOH urges the public to remain patient as we expect initial demand to exceed availability, resolving in the following weeks.

To make a vaccine or booster appointment, visit VaccinateWA.org, or call the COVID-19 Information Hotline at 833-VAX-HELP. Language assistance is available. Those individuals with further questions are encouraged to visit DOH’s COVID-19 Vaccine Frequently Asked Questions webpage or talk to their trusted healthcare provider.

Will Covid Spike Again This Fall? 6 Tips to Help You Stay Safe

Last year, the emergence of the highly transmissible omicron variant of the covid-19 virus caught many people by surprise and led to a surge in cases that overwhelmed hospitals and drove up fatalities. Now we’re learning that omicron is mutating to better evade the immune system.

Omicron-specific vaccines were authorized by the FDA in August and are recommended by U.S. health officials for anyone 5 or older. Yet only half of adults in the United States have heard much about these booster shots, according to a recent KFF poll, and only a third say they’ve gotten one or plan to get one as soon as possible. In 2020 and 2021, covid cases spiked in the U.S. between November and February.

Although we don’t know for sure that we’ll see another surge this winter, here’s what you should know about covid and the updated boosters to prepare.

1. Do I need a covid booster shot this fall?

If you’ve completed a primary vaccination series and are 50 or older, or if your immune system is compromised, get a covid booster shot as soon as possible. Forty percent of deaths are occurring among people 85 and older and almost 90% among people 65 and over. Although people of all ages are being hospitalized from covid, those hospitalizations are also skewing older.

Unvaccinated people, while in the minority in the U.S., are still at the highest risk of dying from covid. It’s not too late to get vaccinated ahead of this winter season. The United Kingdom, whose covid waves have presaged those in the United States by about a month, is beginning to see another increase in cases.

If you’ve already received three or more covid shots, you’re 12 to 49 years old, and you’re not immunocompromised, your risk of hospitalization and death from the disease is significantly reduced and additional boosters are not likely to add much protection.

However, getting a booster shot provides a “honeymoon” period for a couple of months after vaccination, during which you’re less likely to get infected and thus less likely to transmit the virus to others. If you’ll be seeing older, immunocompromised, or otherwise vulnerable family and friends over the winter holidays, you might want to get a booster two to four weeks in advance to better shield them against covid.

You may have other reasons for wanting to avoid infection, like not wanting to have to stay home from work because you or your child is sick with covid. Even if you aren’t hospitalized from covid, it can be costly to lose wages or arrange for backup child care.

One major caveat to these recommendations: You should wait four to six months after your last covid infection or vaccination before getting another shot. A dose administered too soon will be less effective because antibodies from the previous infection or vaccination will still be circulating in your blood and will prevent your immune cells from seeing and responding to vaccination.

Read the full article from KHN.

Public health experts recommend the flu and COVID-19 vaccines for everyone age 6 months and older

The Washington State Department of Health (DOH) is urging the public to get an influenza (flu) vaccine in addition to a COVID-19 booster this fall to keep themselves and others safe and out of the hospital.

In recent years flu activity was low due to the preventive benefits of social distancing, masking, and other COVID-19 precautions. Now that guidance and recommendations have relaxed, people are more active, mobile, and have returned to traditional gatherings. At the tail of the last flu season, Washington experienced an unusual late spring wave of flu.

With the start of fall, many adults have returned to in-person work and most children are back in school. These conditions could lead to an increase in flu or COVID-19 cases this fall or winter.

“Flu can be unpredictable and sometimes severe,” said Tao Sheng Kwan-Gett, MD, MPH, Chief Science Officer. “To protect your family’s health, getting vaccinated against influenza with a flu shot or nasal spray vaccine should be part of the fall routine for everyone 6 months and older. It’s also the perfect time to get up to date on COVID-19 vaccines and boosters too.”

Young children, pregnant people, those with underlying health conditions, and people aged 65 and older are at high risk for flu-related complications. The flu is a highly contagious disease that can cause severe illness and lead to hospitalization and death – even in healthy, young people. Getting a flu vaccine reduces the chance of flu illness and protects individuals from serious flu symptoms. The flu shot can be safely given at the same time as a COVID-19 vaccine or booster.

Flu illness is more dangerous than the common cold for children, especially for children under 5 years old. Flu can be deadly in young children. About 80% of flu-related deaths in children are in those who were not vaccinated. Across Washington, the flu vaccine, and all recommended childhood vaccines, are available at no cost for everyone age 18 years and younger.

For weekly flu activity reports, educational materials, vaccine information, and other flu prevention resources, visit www.KnockOutFlu.org. For more information on COVID-19 vaccines, visit the COVID-19 website.

New KFF/CNN Survey on Mental Health Finds Young Adults in Crisis

An overwhelmingly majority (90%) of Americans believe the nation is in the midst of a mental health crisis, and young adults appear to be suffering the most, a new KFF-CNN survey on mental health in America reveals.

A third (34%) of adults under age 30 rate their mental health as “only fair” or “poor,” compared to 19% of those ages 30 and older. Half (52%) say they “always” or “often” felt anxious over the past year (28% for older adults), and about a third say they always or often felt depressed (33%) or lonely (32%) in the past year, also significantly higher than for older adults (18% each among those ages 30 and older).

In addition, about a third (35%) of young adults say they have been unable to work or engage in other activities due to a mental health condition in the past year, a rate significantly higher than older adults.

Read the full article from KFF.

Medicaid’s Essential Role in Improving the Mental Health of America’s Most Vulnerable Youth

Since well before the COVID-19 pandemic began, the number of young people diagnosed with a mental health need has been increasing, particularly among ethnic minorities, low-income households, and those involved with the child welfare and juvenile justice systems. In response, there has been an increased focus over the past year on strengthening behavioral health services for children and adolescents. A recent report from the Surgeon General describes “a national emergency in child and adolescent mental health” and offers several recommendations, including expanding access to response teams and funding community-based care systems to connect families with evidence-based interventions in their homes, communities, and schools.

Prevention and screening are also essential to meet the needs of young people at risk of mental health challenges. Fortunately, in 2013, the Centers for Medicare and Medicaid Services (CMS) issued guidance outlining the need to provide mental health and substance use treatment to members under age 21, including behavioral health screening and preventive services. Medicaid, which covers approximately 27 million young people, addresses this priority by offering the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which requires states to provide medically necessary services to people under 21 who may be experiencing a mental health need. EPSDT is more comprehensive than commercial insurance benefits, ensuring access to physical and mental health care that promote healthy development and to treatment that addresses symptoms before they worsen. This is a powerful tool; Medicaid-eligible youth are entitled to EPSDT benefits regardless of whether the service is covered in their state’s Medicaid program.

The recent launch of the national 988 suicide and crisis hotline has spotlighted efforts to ensure the availability of behavioral health mobile crisis teams. But preventive services and behavioral health screening can prevent youth from requiring an intervention in the first place. The Center for Medicaid and CHIP Services estimates that 11 percent of youth have a mental health diagnosis, and that at least two-thirds of those youth were not identified as receiving any mental health service. Attending to the wellness of caregivers is also part of ensuring healthy children and strong attachment with caregivers. In 2016, CMS issued guidance allowing for maternal depression screens as part of the EPSDT benefit. A 2018 survey found 31 states and Washington, D.C., allow maternal depression screening to be billed under the child’s Medicaid.

Read the full article from the Commonwealth Fund.

COVID-19 Boosters

The CDC recently recommended the following updated mRNA COVID-19 vaccine boosters to help restore protection that has waned since previous vaccination and target more transmissible and immune-evading variants:

  • The Moderna bivalent mRNA COVID-19 booster is authorized for people 18 and older.
  • The Pfizer bivalent mRNA COVID-19 booster is authorized for people 12 years and up.

These boosters are referred to as “bivalent” vaccines because they target both the original strain of COVID-19 and the Omicron BA.4 and BA.5 subvariants currently circulating in the United States. These updated boosters will help better protect us against these and future variants that might be closely related to Omicron.

Everyone who is eligible to receive the bivalent booster – including those who are moderately and severely immunocompromised – are recommended to receive ONE dose of the booster regardless of how many doses they have received previously. Those eligible may receive the updated booster if at least 2 months have passed since their last COVID-19 dose (either the final primary series dose or the last booster).

The original (monovalent) mRNA COVID-19 vaccine boosters are no longer authorized for people aged 12 years and older and can no longer be given to them, even if they had not previously received a monovalent booster dose. Children ages 5-11 should still receive the monovalent booster (at least 5 months after their second dose).

Routine Childhood Immunizations, Seasonal Influenza, & COVID-19 Vaccination can be co-administered

COVID-19 disrupted both in-person learning and routine well-child visits for many children. As a result, tens of thousands of children and adolescents have fallen behind on receiving recommended vaccines.

Timely vaccination is critical, as immunization schedules are designed to provide children with immunity early in life before they may be exposed to life-threatening diseases. Not only do delayed or missed vaccines leave children vulnerable to illness but when vaccination rates fall even just a little, vaccine-preventable diseases can spread easily.

We know from studies conducted throughout the pandemic that receiving a COVID-19 vaccine at the same time as routine immunizations is safe. If multiple vaccines are due, giving more than one vaccine at the same visit is important because it increases the probability that an individual will be up to date with vaccines.

In addition, with both influenza and COVID-19 viruses circulating, getting both the Flu and COVID-19 vaccines is important for prevention of severe disease, hospitalization, and death. CDC recommends health care providers offer influenza and COVID-19 vaccines at the same visit, with each dose administered in separate limbs.

A Review of 62 Studies Finds Few Big Differences Between Traditional Medicare and Medicare Advantage on a Variety of Measures

Enrollees in Medicare Advantage Were More Likely to Get Routine Check-ups and Immunizations, While Those in Traditional Medicare Were More Likely to Receive Care in the Highest-Rated Hospitals. Rates of Satisfaction Were Similar Among Both Groups.

With the Medicare open enrollment period set to begin Oct. 15, a perennial decision faced by Medicare beneficiaries is whether to get their coverage through traditional Medicare or the private plans known as Medicare Advantage.

A new KFF review of 62 studies published since 2016 that compares Medicare Advantage and traditional Medicare on measures of beneficiary experience, affordability, utilization, and quality finds few differences that are supported by strong evidence or have been replicated across multiple studies. For example, beneficiaries in both coverage types reported similar rates of satisfaction with their care and overall measures of care coordination.

Notably, relatively few studies specifically examined specific subgroups of interest, such as beneficiaries from communities of color, living in rural areas, or dually eligible for Medicare and Medicaid, making it difficult to assess the strength of the findings or how broadly they apply.

In some areas, however, the research identified noteworthy differences between Medicare Advantage and traditional Medicare, including:

Medicare Advantage:

  • Medicare Advantage enrollees were more likely than those in traditional Medicare to report having a usual source of care. They were also more likely to receive preventive care services, such as annual wellness visits and routine checkups, screenings, and flu or pneumococcal vaccines.
  • Medicare Advantage enrollees reported better experiences getting needed prescription drugs than traditional Medicare beneficiaries overall. However, among beneficiaries with diabetes, cancer, or a mental health condition, findings were mixed.
  • Most studies found that utilization of home health services and post-acute skilled nursing or inpatient rehabilitation facility care was lower among Medicare Advantage enrollees than traditional Medicare beneficiaries, but were inconclusive as to whether that was associated with better or worse outcomes.

Traditional Medicare:

  • A somewhat smaller share of traditional Medicare beneficiaries than Medicare Advantage enrollees experienced a cost-related problem, mainly due to lower rates of cost-related problems among traditional Medicare beneficiaries with supplemental coverage. (But traditional Medicare beneficiaries without supplemental coverage had the most affordability-related difficulties.)
  • Traditional Medicare outperformed Medicare Advantage on measures such as receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies.

In other areas, though, findings were mixed or showed little difference between Medicare Advantage and traditional Medicare based on multiple studies.

Among the findings:

  • There were generally no differences in the aggregate number of hospital days or average length of stay for common medical admissions.
  • Neither Medicare Advantage nor traditional Medicare consistently performed better across all quality measures.
  • Additionally, two analyses of several measures of beneficiary experience found no differences between the two groups in experiences with wait times and in the share reporting trouble finding a general doctor, being told that their health insurance was not accepted, and being told they would not be accepted as a new patient.

Findings related to the use of other health care services, including hospital care and prescription drugs, and condition-specific quality of care measures varied – likely due to differences in data and methodology across studies.

Interest in how well Medicare Advantage plans serve their growing and increasingly diverse enrollee population has never been higher, as Medicare Advantage, for the first time, is projected to enroll more than half of all eligible Medicare beneficiaries next year, making it the main way that Medicare beneficiaries get their coverage and care. In comparison, just over a decade ago in 2010, 25 percent of the eligible population was in a Medicare Advantage plan.

The Medicare open enrollment period runs through Dec. 7.

The full analysis, Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature, as well as more data and analyses about Medicare Advantage, are available at kff.org.