NEW YORK (Reuters Health)—Medicare Advantage plans might not be meeting the needs of patients requiring the costliest and most complex levels of care, a new study suggests.
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 Dr. 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.
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.
The researchers analyzed 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 the year.
Overall, there was little difference, with 4% of traditional Medicare beneficiaries switching, compared to 5% 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% of people in nursing homes for long stays switched from Medicare Advantage to traditional Medicare between 2010 and 2011, while only 3% moved in the opposite direction.
Also, 8% of people receiving home healthcare switched from Medicare Advantage during that time, compared to 3% switching from traditional Medicare.
