Insurers clearly have not figured out how to profit from the Medicare hospice benefit, which offers comfort care for people who are terminally ill. Caitlin Owens reports for Axios that a government trial to include the Medicare hospice benefit in Medicare Advantage is ending six years sooner than planned because insurers and hospice agencies alike cannot make the benefit work to their liking. The Centers for Medicare and Medicaid Services, CMS, which oversees Medicare, claims the pilot was not a failure. What would you call it?
Right now, if you are enrolled in a Medicare Advantage plan and elect the Medicare hospice benefit–choose to forgo curative treatments for your condition in favor of palliative care–traditional Medicare covers the hospice services, even though you are still enrolled in a Medicare Advantage plan. [N.B. Unfortunately, the hospice benefit is only truly available to people who have someone to take care of them at home and ensure their safety when the hospice aides are not there. The hospice benefit does not provide 24 hour care.]
Juggling between traditional Medicare for your hospice care and Medicare Advantage for all unrelated health care services can be a bear. And, it can be a big bear for the more than 800,000 people enrolled in Medicare Advantage who elected hospice in 2022–about half the Medicare Advantage enrollees who died in 2022.
In 2021, the Center for Medicare and Medicaid Innovation (CMMI) launched a pilot to permit insurers offering Medicare Advantage to coordinate hospice care for their enrollees directly. The question is whether Medicare Advantage plans can make getting hospice services easier for their enrollees, bring down costs, and improve quality of care. The pilot was scheduled to run through 2030.
The Medicare Advantage hospice experiment will now end in 2026. Neither UnitedHealth Group nor Elevance, two of the biggest insurance companies offering Medicare Advantage, who had been part of the pilot, wanted to continue participating. Only 13 insurers were participating.
For the most part, hospices agencies were pleased that the insurers pulled out. Insurers were not paying them adequately and their administrative burdens were significant. But, without a hospice benefit, Medicare Advantage cannot provide seamless care at the end of life; it makes Medicare Advantage accountability and enrollee costs all the more complicated for hospice enrollees.
Here’s more from Just Care:
- Choose your hospice provider carefully
- High proportion of people flee Medicare Advantage at end of life
- Profiteers turn hospice into a $22 billion industry
- Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care
- Medicare hospice benefit has become a luxury
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