EP291: What Are Medicare Advantage Plans Up to Right About Now? With Betsy Seals, Cofounder of the Rebellis Group

In this Episode 291, Stacey Richter talks with Betsy Seals, cofounder and chief operating officer of the Rebellis Group, about what Medicare Advantage plans are up to right now.

WHAT YOU'LL LEARN

✅ Why disenrollment rates and member complaints are top of mind for MA plan leaders right now

✅ How CMS's midyear benefit-change flexibility let MA plans respond to members' pandemic-driven needs

✅ Why supplemental benefits are becoming a bigger factor in how beneficiaries choose a plan

✅ Why understanding local social determinants of health matters more than ever for MA plans

✅ What providers should understand about partnering with MA plans right now

WHY THIS MATTERS

Betsy Seals explains that Medicare Advantage plans are under real pressure to prove their value beyond just network adequacy — beneficiaries now expect telehealth, supplemental benefits, and a plan that actually understands the social determinants affecting their local population. CMS's pandemic-era flexibility to adjust benefits midyear gave plans a chance to respond in real time, and how they used that flexibility will likely shape enrollment in the coming annual enrollment period. For providers, Seals sees a missed opportunity: closer partnership with MA plans, built on a shared understanding of how the market and beneficiary expectations have shifted.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:45 What is a Medicare Advantage plan?

04:02 The core imperatives for leaders of Medicare Advantage plans.

04:31 "How is risk adjustment functioning?"

04:34 Making disenrollment rates and member complaints top of mind for MA leaders.

05:40 "We all want to know why members are leaving. Well, they're telling you!"

05:50 Star rating measures.

07:33 "Will Medicare beneficiaries really have confidence … going into the doctor's office … next year?"

09:11 "Now, it's not just 'Is your doctor in the network?' It's 'Does your plan also offer telehealth?'"

12:13 "When you really look at Medicare beneficiaries aging into the program or … younger … beneficiaries, their shopping trends and their consumer expectations are very much the same as yours and mine."

13:58 CMS's adjustment in April that allows MA plans to make changes to their benefits midyear to provide to beneficiaries' changing needs during the pandemic.

16:01 Supplemental benefits as a decision-making factor in enrollees' Medicare Advantage plan selection.

16:28 "The decisions made during this time with how to increase benefits or how to address the issues going on with your membership will have a really great impact on [your] AEP [annual enrollment period]."

18:12 "I think that there's a real lack of understanding … around what issues are impacting their actual membership … but really understanding the demographics and the social determinants of health that are impacting your local landscape."

19:30 "Health care's not always related to in-office doctor visits."

19:40 "I really do think that CMS is headed … to understanding that federal dollars for the Medicare program should not just be spent on doctor's visits or screenings."

21:10 "I think that there's been a real shift in … what we understand now and also what we're able to predict."

23:24 Where Medicare Advantage plans fall in addressing population health management, working with hospital organizations, and social determinants of health.

24:24 Betsy's advice for providers dealing with MA plans.

24:46 "I … think that this is … a missed opportunity [for] provider and plan partnership in a lot of ways."

26:07 "Really understanding that the market has shifted and the way the beneficiaries enroll this year is going to be very different than it ever has been before."

29:25 "One thing that shouldn't be overlooked is that we really have an opportunity to dig into the data."