Medicare Advantage Expert Kristine Grow Explains its Growth and Popularity

Medicare Advantage is different from Medicare. The difference can itself make a big DIFFERENCE in the health and lives of seniors and others who have debilitating illnesses that require expensive treatment or out of the ordinary care.

Sam Yates, your grey-haired host of the Great American Senior Show caught up with Medicare Advantage expert Kristine Grow, Senior Vice President, Communications, Americas Health Insurance Plans (AHIP) to find out why Medicare Advantage is such an advantage to seniors, especially those who are low income or with limited income. 

Transcript

Sam Yates: 0:12

Hello, everyone, and welcome to another exciting edition of The Great American Senior Show. I'm your gray hair and host Sam Yates. And today, we're going to be talking about Medicare Advantage. We have as a special guest and expert Christine Grows. She's the Senior Vice President of Communications for a AHIP, and I'm going to let her explain that it's a trade association that represents the health insurance providers who literally cover hundreds of millions of Americans with insurance for health care. Kristine, welcome to the program.

Kristine Grow: 0:50

Thank you very much for having me.

Sam Yates: 0:51

Tell us about that organization. Christine?

Kristine Grow: 0:53

Sure, AHIP represents health insurance providers who provide coverage for about 300 million Americans today. So we have a population in this country of about 330 million Americans. Three, upwards of 300 million of them now have coverage, whether that's through their job through Medicare through Medicaid or whether they buy it on their own. So our focus is to make sure that people have access to the affordable high quality coverage that they deserve. We are looking to make coverage and care more affordable and accessible for everyone. So that means focusing on value and focusing on lowering their costs.

Sam Yates: 1:31

For our audience, I want you all to know that Christine has a very special background in the healthcare industry, Aetna, Humana, just to name a few. Tell us about your background a bit.

Kristine Grow: 1:43

I know communicator who has been working with organizations for all my career all my life. But over I'd say for more than a decade now I've worked at health insurance providers including Aetna was working with Aetna as they were working on their proposed merger with Humana which of course did not happen. But both players of course, are very big in the Medicare Advantage space Medicare Advantage is a very important focus for them. So through that work, what I had the opportunity to see was their commitment to seniors and people with disabilities, how they are very sensitive and attuned to the health care issues that are important to them, what is important to them and their coverage, what they really value, and how we focus on measures and services that help them to achieve their best possible health. And

Sam Yates: 2:36

certainly, that's, that's a desired outcome, especially here at Florida, I think our numbers are approximately 2.5 million seniors that are enrolled in Medicare Advantage that sound about right

Kristine Grow: 2:49

2.5 million Florida residents who are in Medicare Advantage. So that's about 51% of the population. So that is the majority. But we find that in many places, including Florida, what these seniors are looking for is better services, better access to care better value, and they're choosing Medicare Advantage for that coverage.

Sam Yates: 3:10

I want to make sure that our audience also knows that when we talk about Medicare Advantage, that Medicare label may mean to some people, oh, that's only senior citizens. But there are others who could and do qualify for Medicare Advantage. Give us a little explanation.

Kristine Grow: 3:29

Sure, if you are the age of 65 or older, or if you are a person, a younger person with certain disabilities, you qualify for Medicare, and that those disabilities can include end stage renal disease or ESRD. So rely on the Medicare program

Sam Yates: 3:45

familiar with that. I've been looking into it on another topic myself quite a bit lately. When we do talk about keeping our seniors healthy, of course, you know, I think the big question everyone wants to know, if they are not in a Medicare Advantage Program, should they take a look at it? Should they not when can they become part of it? What are the guidelines when you

Kristine Grow: 4:08

qualify for Medicare Medicare Advantage can be a choice of a plan that you can opt into. So when you when you start shopping or looking at Medicare, there are different parts of Medicare. Original Medicare is what's called Part A and B, Part A covers hospitalization and inpatient care. Part B covers outpatient care like a doctor visit. Medicare Advantage wraps around all of that to cover that and more. So it can cover things like hearing care, vision, dental care, prescription drugs, services, it covers a lot of your prevention care and your wellness care. They can even offer fitness programs and other programs that can address the social determinants of health that happen outside of a doctor's office but still have a huge impact on people's ability to stay healthy. One of the things

Sam Yates: 5:00

that we watch carefully here through the Great American seniors show is how our lawmakers are addressing our seniors, not just here in Florida, but throughout the entire throughout the entire country, we have a focus in Florida, but we talk about topics for the entire nation. When it comes down to the state level, a lot of folks are gonna go, well, let's see, Medicare is a federally regulated program. But at a state level, our legislators can have an impact on Medicare Advantage programs and their operations, because those are private providers. How does that work?

Kristine Grow: 5:43

Every year, members of Congress and the administration take a look at the Medicare Advantage program to see is it delivering the value for America's seniors and people with disabilities, things like, you know, look at the rules and regulations guiding the benefits that can be offered through these plans. They look at what's invested into the program to ensure that it remains stable and strong and secure. So it's meeting the needs of seniors and that remains strong. And what we find is that members of Congress across the board, no matter where they fall on the political spectrum, they support Medicare Advantage, because they do know it's so important for seniors and people with disabilities. And in fact, members of Congress every year send letters to the administration, regardless of which administration, it is to let them know how much they value and Medicare Advantage and think it's important to protect it for America's seniors. And in this past year, all of the senators that we reached out to to say that this was important, all the members of Congress that we reached out to to say it was important signed on to those letters of support. So Senator Scott, Senator, Rubio, various representatives within the house, they all believe that Medicare Advantage is important to protect. So I would say to the residents of Florida, it's very important for you to reach out to your members of Congress to let them know what's important to you, they do listen to you, they do keep that a priority. And that's one thing that we're very supportive of is having people have their voice heard. And I think that's critically important.

Sam Yates: 7:18

Here in Florida. I'm involved in a number of health care coalition's throughout the state, as well as being in touch with the Area Agency on Aging for all of Florida's 11 regions on an ongoing basis. And that's what they like to underscore, underline, contact your legislators and let them know what we, as the AAA agencies or other health care providers within the senior segment, let them know we're doing a great job that and I think that's something that a lot of people tend to take for granted.

Kristine Grow: 7:51

That's right. I think there's there's a lot of skepticism and you know, it can be you know, hard to, to keep your momentum up and your energy up if you're not sure if your voice makes a difference. But I'm here to tell you that the members of Congress are listening and your voice does, in fact, make a difference to them. So if you have a perspective, especially when it comes to health care, you should make sure that your voice is heard. In your

Sam Yates: 8:13

position, you're also part of a much larger coalition for Medicare Advantage type programs. Is that coalition seeing any future threats to Medicare Advantage?

Kristine Grow: 8:27

Yeah, the coalition that that we are focused on is the Coalition for Medicare choices, which is found at Medicare choices dot o RG and I invite every senior who's interested in this any Floridian who's interested in this to visit our website and learn more. This is about 2 million seniors who come together to focus on Medicare Advantage, they pay very close attention to what the administration and members of Congress are doing to the program. And they look at it every year. As I mentioned, you know, there are new rules and regulations and right notices that come out for this program every single year. And those seniors are watching to see what does that mean for the program? What does it mean for the benefits that I've come to appreciate? We've especially seen them very active over the past couple of years through the COVID 19 crisis. Right. And that, as you know, that has caused a lot of new areas of interest in concern about how do I access my care? How do I get it safely? What kinds of benefits do I have access to can we make them more flexible? Telehealth was very important to a lot of seniors because they may not have wanted to risk contracting the COVID 19 virus with a visit to the doctor. A lot of them use telehealth and there were new flexibilities introduced by the federal government that allowed telehealth visits and more telehealth visits to happen so that seniors could get that care and the safety and the comfort of their own home. Now that they've had that and they've seen how well it works, seniors and doctors both really like tell Health. So the coalition has been very strong. And you know, the the flexibilities that we've seen through the pandemic, they should really continue. Because we've seen a lot of benefits, we see that it works. This is a way to sustainably improve our health care system. So So let's make some of those changes permanent. Which

Sam Yates: 10:15

brings us to another topic, and that is aging in place. And certainly Medicare Advantage plays a role for people aging in place.

Kristine Grow: 10:24

Absolutely. And health insurance providers very strongly support Americans being able to age in place, because a lot of them prefer that. So what does that mean for your health care services and coverage, that means having more health care visits at home, it means having other support experts and professionals visit you at home to see how you're doing, make sure that you have healthy food that your environment is a safe environment. And that can include things like you know, do you have anything in your home, that could be a risk to walls? Do you have stuff to traverse? Are there other ways that we can provide you with access to your home so that you can remain safe, reduce your risk of injury or illness? You know, we've also had Medicare Advantage Plans who have gone into the home and seeing that, you know, perhaps you're someone who doesn't have it? Well, heating or cooling system that's working well for you, they can provide you with connections to ensure that you have heating and cooling because that's very important to keeping you healthy. And well, for a long period of time. These plans are very focused on helping seniors stay healthy. And all of these programs that Medicare Advantage is working on these additional supports and services that they're providing access to. It's all about helping our seniors and people with disabilities get healthier, faster and stay healthier, longer.

Sam Yates: 11:52

And I'll just put in a plug for our area agencies on aging, they are doing a wonderful job as far as getting the information out about the various programs and a number of them are using our programs and using our program to get this old fashioned thing called Radio on the internet now called podcast into a lot of the facilities that we have listening parties and things like that. But the bottom line is all of them, I have a very sincere person on the other end of a telephone on a hotline that can answer your question. So if anyone has questions reach out to your area agency on aging, and they'll help answer your questions. And of course, your organization is supplying a lot of that information.

Kristine Grow: 12:43

That's right. And I would also say that the health insurance providers with the plans, their focus is getting into the communities. So how do we help the community with the resources they had and where they are and where they most need and want that support. So they create local relationships with these organizations, they have helped to bolster what they are doing and leverage their infrastructure and their connections, because they know the community best and they know how best to deliver the services and meet the people for what they need what they deserve.

Sam Yates: 13:15

While there is an overall program, no individual county or region in Florida is a cookie cutter, what might be very important in North Florida, that might not be applicable for another area. So whatever your questions are, contact your insurance provider or the area agencies on aging. A critical factor that cuts across all the board though, is the caregivers themselves. We're seeing a significant shortage of caregivers for two reasons. One, the COVID pandemic, hopefully coming out of that now, but the other is just the reimbursable. For the caregivers, any relief on the horizon,

Kristine Grow: 13:56

I think the caregiver issue is a very important one. And it's both professional caregivers, as well as caregivers who are your family and friends and people within your community. And they all need support. So this has been something that health insurance providers has been working a lot for, you know, it's it's, you know, it's not just about payments, but it's also about the workforce and the number of people who are available. It's about ensuring that they have the education and training to get the certifications that they need. The additional supports that they have good career pathways open to them. All of these are really important. And you know, it's all of these are different programs. Again, it will depend on the community and who you're working with and what support you're looking to provide because they're very individualized sorts of solutions. Again, like you said, it's not a cookie cutter approach, but I also don't think that we can overlook the fact that family and friends can also use some support and relief. So a lot of these health insurance providers who provide Medicare Advantage plans also reach out to the caregivers to get Have them no additional resources, encourage them to take care of their own mental and physical health, provide them with ideas and other support so that they can get a break themselves. Because if you know if your own tank is empty, you can't help refill someone else's, you have to be able to take care of yourself. So I would encourage anyone who out there who is a caregiver, please do prioritize your own health and wellness as you're taking care of other people, because that's the best way to take care of someone you love.

Sam Yates: 15:30

switch gears if we could, Alzheimer's, dementia are sometimes barriers to someone thinking they can get the proper care but Medicare Advantage does address those

Kristine Grow: 15:42

does. And these are really complex, very serious illnesses and very, very difficult. Especially when it comes to both the patient and the caregiver. There's still so much that's being learned when it comes to Alzheimer's and dementia and new programs that are being worked on all the time. You know, it all comes down to innovation and what is the science telling us is going to work? What are we learning about the disease? You know, a lot of these health care the health insurance providers who offer these Medicare Advantage plans. What I don't think a lot of people realize is they all have chief medical officers and clinical experts who work in these plans. And their job is to stay on top of the science. You know, what is the evidence that's coming down? What are the new promising programs are becoming available? What are the new treatments and solutions that we can take a look at to see if they can be applied to larger populations. And then as we take those learnings and talk with providers in the network about them, we don't look to see, you know, what pilot programs can we start? What can we test what can we try with a smaller population and then possibly expand more as we see that it actually works. So we're hopeful that we're going to be seeing more innovation and more promising studies come out in this area, because it's a growing concern for many Americans.

Sam Yates: 17:05

And all the tests to the way that some of those programs that are very, very special programs work. We work closely with the Brevard Alzheimer's Foundation in court, one of the things that we have seen implemented under Medicare Advantage are called SNPs. special needs programs for the patients that that may not have exactly what they need is, can you explain a little bit about SNPs? For us?

Kristine Grow: 17:34

Yeah, SNPs are a very critical area and very specialized. That one of the things that that does raise is Medicare, the Medicare population is not a monolith, you know, you don't have one particular sort of person who qualifies for Medicare. You also have a lot of people in the program who have very serious disabilities and a lot of people who are lower income. So a lot of people are not aware you can jointly qualify for both Medicare and for Medicaid. Medicare is for people over the age of 65 with surrender, or with certain disabilities. Medicaid is for lower income Americans. So you can qualify for both programs. And in that intersection of what we call the dual eligibles. A lot of these snips programs that care for a variety of those needs. And what we often call high intervention or you can think of high assistance kinds of programs are designed again to get these people comfortable, get them as healthy as they can possibly be and help them to live life on their own terms.

Sam Yates: 18:43

Anytime there is a hospital or a care facility involved that in some way accepts Medicare funding. They are extremely critically aware of the need to cut hospital readmissions. And what strikes me and and seeing what I have seen about the Medicare advantage is that it is a little bit different than than just typical Medicare that is a little bit more cookie cutter because the insurance providers also want and do cut that readmission rate.

Kristine Grow: 19:17

That's right. So what is the hospital readmission? It's in a situation when you were in the hospital for procedure for treatment, you go back home and then something happens in short order afterwards that requires you to go back into the hospital to continue care or treatment or have something else treated or cared for that may have occurred or started when you were in the hospital. That's not good for anybody. The senior the person you know the patient does not want to have to go back to the hospital they were already there. They want to be home. They want to be well and readmission. is a is a quality measure. It's what what are you getting the best quality Do you have care when you are initially in the hospital, and through delivering that better care, you actually cut the overhead costs or unnecessary costs for health care so that health care can be more affordable for everyone. If you're spending less on health care because more people are healthy, premiums go down out of pocket cost costs go down and more people can afford their coverage. So we're very focused on reducing avoidable readmissions that requires a lot of partnership and coordinated care so that care teams are working together, and ensuring that we're measuring the right things and caring for the patient as an individual. And in fact, for Medicare Advantage. If you look at 16 out of 16, clinical quality measures that are looked at Medicare Advantage out scores and outperforms Original Medicare, in every instance, a

Sam Yates: 20:55

question on Medicare versus Medicare Advantage, I literally ran into a gentleman recently who said, Well, you know, I tried Medicare Advantage, it wasn't exactly what I was thinking it was going to be during the next eligibility period, he switched from Medicare Advantage back to Medicare. And it was not what he expected either. And then he switched back and discovered a period of time switch back to Medicare Advantage. Once you go into one or the other, you're not really locked into one or the other are you

Kristine Grow: 21:30

just like you choose your employment benefits at your employer every year, we have in Medicare, what's called the open enrollment period, when you first qualify for Medicare, it's very important to sign up for Medicare. So you should ensure that you do get Medicare because there are penalties and other things that you would have to face if you don't sign up for Medicare immediately. So I would encourage everyone to at least consider that. Then when it comes to your health care coverage, you have this open enrollment period that runs from October, mid October to mid December, where you can look at your choices and make a choice that's best for you. Not only is there Original Medicare and Medicare Advantage, there are also what are called Medicare supplement plans, they're all a bit different. There are a lot of different versions. But there are a lot of choices that you can think about what we encourage folks to do, as you're thinking about what coverage is right for you is look at the doctors that you want to see and that you like, look at the kinds of care that you think you're going to want to get in the coming year, look at the prescription drugs that you need, and make sure that they're all covered by the networks and the formularies, to make sure that you're considering all of the costs. It's not just about the premiums that you pay each month. It's also about the out of pocket costs for all those additional services that you could need. So it's really a package of affordability.

Sam Yates: 22:51

Christine, I know we've covered a lot of material, and someone listening in right now may have additional questions. Where should they go? If they have those additional questions?

Kristine Grow: 23:03

Anyone who has questions, I will break that down into a couple of ways. So if you're looking to find out more about Medicare as a program, the federal government has a great website medicare.gov. They have a great 800 Number one 800 Medicare. So that's a lot of really great basic information. If you'd like to learn more about Medicare Advantage and the Coalition for Medicare choices, come over and visit us at Medicare choices dot o RG we have a lot of stories, we have a lot of information and we'd love you to take a look at them.

Sam Yates: 23:33

I always ask this question of my guest. Would you be able to come back again in the future as there's new information or we might just need to remind everyone again of what Medicare Advantage is all about.

Kristine Grow: 23:47

I'd be delighted to anytime

Sam Yates: 23:48

Kristine Grow. I want to thank you very much for being here on our program today.

Kristine Grow: 23:54

Thank you so much. It's been a pleasure.

Sam Yates: 23:56

And until our next episode of The Great American Senior Show. I'm your gray haired host, Sam Yates and that's the way our program is