Private Payers News

Medicaid Service Equals or Surpasses Private Health Payers

Medicaid provides equal or better care access and billing service than private health payers, according to the Commonwealth Fund.

Medicaid results equal or higher than private plans

Source: Thinkstock

By Jesse Migneault

- A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans. 

The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related to access to care, quality of care, and problems related to medical bills.  

The study found Medicaid recipients rated ahead of private payers in two main areas: better access to health care and fewer problems related to medical bills.  Uninsured individuals rated last in all categories measured.

Medicaid is currently the nation’s largest health insurer, with 70 million people receiving healthcare coverage.   That number includes 12 million enrollees who became eligible under the 2010 Affordable Care Act (ACA) Medicaid expansion.

For the study, private insurance coverage included employer-sponsored and individual plans. Private coverage also included payer plans purchased through ACA marketplaces.

Overall, coverage rates for individuals throughout the year indicated 91 percent of Medicaid enrollees had a regular source of care, versus 93 percent of those with private health insurance plans.  Seventy-seven percent of uninsured people reported coverage for some part of the year. 

Medicaid enrollees rated highest in member satisfaction, with 57 percent of Medicaid members citing the care they received as very good or excellent.   This contrasted with 52 percent of the privately insured and 40 percent of the uninsured.

Medicaid members also reported fewer challenges with cost-related access to healthcare.  Medicaid beneficiaries were less likely to avoid or defer needed prescriptions, routine tests, or speciality care due to financial concerns.

Medicaid enrollees faced significantly less complicated medical billing issues, the report found.  Survey results showed Medicaid plan members have fewer outstanding bills, fewer collection actions, fewer lifestyle changes due to medical debt and the highest overall ability to pay medical bills. 

Private plans and Medicaid provided nearly equal levels of clinical care, however.   The rate of enrollees receiving preventative care under Medicaid was on par with  private plan members.  Statistics for members receiving blood pressure, cholesterol checks and flu shots also showed parity.   This coincided with even rates for cancer screenings, such as mammograms and colorectal cancer screenings.

So far, 31 states have expanded Medicaid under the ACA.  The continued political debate over the ACA expansion often centers around federal subsidies and quality of care concerns. 

A common argument against Medicaid is that the quality of care pales in comparison to private coverage.

“There is a common misperception that Medicaid is not good health insurance, and these results tell us that simply isn’t the case,” said Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund, and a coauthor of the report. “Medicaid is giving people what they want and need—affordable health insurance and access to care”

The Commonwealth Fund Biennial Health Insurance Survey,2016 was conducted from July to November 20, 2016.  It included a random sampling of 6,005 adults within the United States. The age of respondents was limited form 19-64.