Becker’s Payer Issues reports that Medicare Advantage Special Needs Plans–health plans for people with Medicare and Medicaid–are the fastest growing segment of the Medicare Advantage market. They offer coverage in 45 states. But, at least one study of Special Needs Plans suggest that they might not offer better care management than standard Medicare Advantage plans, even though they cost more.
Nearly half of dual-eligibles–people with Medicare and Medicaid–are enrolled in a Special Needs Plan, about 5.5 million out of 12.5 million. The vast majority of them (87 percent) have incomes under $20,000 a year. Four in ten of them have incomes under $10,000.
One in eight dual-eligibiles (13 percent) are living in a long-term care facility. Only one in 100 people with Medicare live in a long-term care facility. And, about half of dual-eligibles are people of color. One in five people in the Medicare population are people of color.
In Traditional Medicare, dual-eligibles represent 17 percent of the population and 33 percent of spending. Inexplicably, spending information for the dual-eligibles in Medicare Advantage is not available. More than four in ten of the dual-eligible population (44 percent) is in fair or poor health; overall, 17 percent of people with Medicare are in fair or poor health.
The government offers people three different types of Special Needs Plans. With 4.9 million enrollees, D-SNPs for dual-eligibles have the largest population. C-SNPs provide care to 450,000 people with chronic or disabling conditions, particularly people with disabilities and cardiovascular disease. And, !-SNPs serve 107,000 people getting institutional care.
Clearly, the health insurance industry sees big dollar signs with Special Needs Plans. They get paid more for dual-eligibles and, as it is, they get paid handsomely for treating the general Medicare population through Medicare Advantage. Enrollment in Special Needs Plans is up more than 17 percent in four years. Enrollment in Medicare Advantagage is up 8.3 percent.
And, you guessed it, UnitedHealthcare covers 39.9 percent of people enrolled in Special Needs Plans. Humana covers 15 percent of people enrolled in Special Needs Plans.
Here’s more from Just Care:
- People with Medicare and Medicaid in Special Needs Plans at extra risk
- What’s a Medicare Special Needs Plan?
- Ten ways to improve Medicare Advantage
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Medicare Advantage plans are an “Insatiable Cash Monster”
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