Plan Design Variations in Medicare Advantage

This white paper examines the variations in plan design within Medicare Advantage (MA) and their impact on enrollment composition and healthcare utilization. It highlights how different MA plans can significantly differ in terms of coverage design and patient out-of-pocket costs, such as premiums and deductibles. The research, conducted by Harvard and Inovalon, utilizes a comprehensive dataset to analyze how these design features influence who enrolls in specific plans and how they utilize healthcare services. The study reveals that zero-premium plans tend to attract a more socioeconomically disadvantaged population compared to higher-premium plans. Furthermore, it compares Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), finding that HMOs exhibit over 25% lower utilization rates than PPOs for similar populations. This work aims to provide valuable analytics to health plans and policymakers, enabling them to optimize MA plan designs and improve healthcare outcomes for beneficiaries.