Between 2010 and 2011, such patients were more likely to switch from
Medicare Advantage plans to traditional Medicare, rather than vice
versa, researchers found.
The results suggest people should carefully consider all the
benefits, payments and quality measures before enrolling in Medicare
Advantage plans, said lead author Momotazur Rahman of Brown
University in Providence, Rhode Island.
Unlike traditional Medicare, which is the U.S. health insurance
program for the elderly and disabled, Medicare Advantage is offered
by private insurance companies. While the plans cover all services
provided under traditional Medicare, Advantage plans may also
include added services like eye and dental coverage. They may also
charge different out-of-pocket costs and offer access to different
sets of providers.
At the beginning of each month, the government pays Medicare
Advantage companies a lump sum to cover enrollees' expenses - with
higher sums for high-risk patients. The plans must follow rules set
by the federal government.
Rahman and his colleagues write in Health Affairs that lump sums
encourage companies to keep healthcare costs low. But there's been
some concern that companies were maximizing profits by enrolling
healthier people, whereas traditional Medicare is obligated to
enroll all comers.
According to the authors of the new study, legislation in 2003 aimed
to address those concerns, and research suggests it helped close the
gap in deaths and healthcare use and spending between people in the
two types of plans.
Other studies, however, have suggested Advantage plans were still
overpaid under the new system and switching between plans was
limited to those needing the most care.
For the new study, the researchers used data on more than 36,000
Medicare beneficiaries, about a quarter of whom were enrolled in
Medicare Advantage plans, to see how many switched from one type of
plan to the other over the course of a year.
Overall, there was little difference, with 4 percent of traditional
Medicare beneficiaries switching, compared to 5 percent of those in
Medicare Advantage plans.
But there was a difference when the researchers looked at people
requiring complex care - with more switching away from Medicare
Advantage plans than from traditional Medicare.
For example, 17 percent of people in nursing homes for long stays
switched from Medicare Advantage to traditional Medicare between
2010 and 2011, while only 3 percent moved in the opposite direction.
Also, 8 percent of people receiving home healthcare switched from
Medicare Advantage during that time, compared to 3 percent switching
from traditional Medicare.
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The results were more exaggerated for people enrolled in both
Medicare and Medicaid, the U.S. health insurance program for the
poor. Those people are allowed to switch anytime and usually use
increasingly expensive care, Rahman said.
It's not clear why people needing higher levels of care are more
likely to switch out of Medicare Advantage plans, said Gretchen
Jacobson, associate director with the Kaiser Family Foundation’s
Program on Medicare Policy in Washington, D.C.
For example, it could be due to limited provider networks, unused
extra benefits or prescription drug needs, said Jacobson, who wasn't
involved with the new study.
However, she said, it's important to point out that the vast
majority of people remain in their chosen programs.
"Most people are not changing when they make an initial decision
about their coverage, but this is an area that’s ripe for more
research," she said.
A representative of America's Health Insurance Plans (AHIP) also
stressed that the study only looked at one point in time, and
changes for Medicare Advantage plans were adopted since that period.
"More specifically, enrollment in Medicare Advantage has continued
to increase year after year as program continues to offer
coordinated care that leads to better outcomes for seniors and those
with chronic conditions," said AHIP's Clare Krusing.
"If the type of disenrollment that was highlighted in this study was
as pervasive as the authors suggest, there would be much greater
evidence that beneficiaries were leaving the program in significant
numbers," she said.
SOURCE: http://bit.ly/1FyXAQN Health Affairs, online October 5,
2015.
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