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People with serious health needs more likely to disenroll from Medicare Advantage plans

Written by Diane Archer

A new study by David Meyers, Brown University School of Public Health, et al., of people enrolled in Medicare Advantage plans, published in JAMA Internal Medicine, shows that people with high health care needs disenroll from these commercial Medicare health plans into traditional Medicare at higher rates than people in better health. Their findings suggest that commercial health plans, overall, are not in business to meet the needs of people with complex conditions.

Medicare Advantage plans have financial incentives to attract healthy members and steer less healthy members out of their plans. The federal government pays these plans a fixed rate per member. The less care each member receives, the more money the health plan gets to keep.

The study’s authors find that rates of disenrollment from Medicare Advantage plans increase after people experience a serious health condition. The Government Accountability Office also has studied this issue and found that a high proportion of people disenroll from Medicare Advantage plans when they have serious health care needs.

We have little clue how poorly the people with complex conditions who remain in their Medicare Advantage plans fare. Some evidence is concerning. In May 2018, Just Care reported on another study showing that enrollees in Medicare Advantage plans are more likely to end up in poorer quality skilled nursing facilities than people in traditional Medicare. More recently, a judge in Northern California found that UnitedHealth illegally denied necessary care to tens of thousands of enrollees with mental health needs.

Poor treatment by commercial health plans of people with costly conditions is one reason why proponents of Medicare for All support improving and expanding Medicare to everyone. Medicare for all would fill gaps in traditional Medicare coverage, eliminating premiums, deductibles and coinsurance and adding vision, hearing, dental and long-term care. Medicare for All would also end commercial health insurance, including Medicare Advantage plans, which drive up costs and differ dramatically from traditional Medicare.

The study’s authors looked at data of 13.9 million people enrolled in Medicare Advantage plans over a two-year period. They found a disenrollment rate of 4.6 percent for people with high needs as compared to a disenrollment rate of 3.3 percent for people without high needs. They infer from the data that Medicare Advantage plans are less likely to meet the preferences of people with complex conditions than people with fewer health care needs.

The authors’ findings confirm what we already know. People with complex conditions are often hard-pressed to see the doctors they want to see and get the care they need when enrolled in a commercial Medicare Advantage plan.

Of course, not all Medicare Advantage plans are alike. The study’s authors suggest that the ones with low star ratings are likely less well-equipped to meet the needs of people with costly conditions. But, the Medicare Advantage plans with five-star ratings could be ones that are engaged in wrongful delays and denials of care; the five-star ratings do not say enough about a plan’s performance to rely upon.

The authors do not disclose the names of the Medicare Advantage plans with the disproportional disenrollment among enrollees needing costly care. Generally, Medicare Advantage plans only allow researchers to use their data on the condition that the researchers not call out particular health plans; in some cases, the researchers do not know which data belongs to which health plans. Keeping this information confidential is a particular disservice to the public.

The authors categorized people as having a high health need if they have two or more “complex chronic conditions such as heart failure, chronic obstructive pulmonary disorder, and depression” or “six or more chronic conditions.”  They also looked at dual-eligibles–people with Medicare and Medicaid.

Dual-eligibles with costly health needs disenrolled from Medicare Advantage plans to traditional Medicare at higher rates than others. But, the authors did not explore whether this is because others may not be able to buy the supplemental coverage they need to fill coverage gaps if they switch to traditional Medicare. The ability to buy supplemental coverage is not guaranteed in many states, except when people initially enroll in Medicare at 65.

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  • I lost two friends to cancer last year who were enrolled in Medicare Advantage plans. One was diagnosed with Stage 3 breast cancer. She had been asking her “advantage” doctor for three years about a lump on her breast. My second friend had prostate cancer but the “advantage” doctor told him not to worry about it until it had metastasized. Bottom line advice – only sign up for Medicare Advantage (or any HMO) if you never plan on getting sick.

    • They keep trying to get to enroll in an”advantage” plan but I figured out that it would probably cost me more than my regular Medicare plus my supplement. I figured it out based on my past years needs and the amount the so-called advantage plan would cover.
      Don’t give in to those ‘representers’ that try to get something that could end up costing more medical expenses you can afford.
      If you are young and super healthy, maybe, but you don’t know what’s in your future.

    • I am on a Medicare advantage plan and am very happpy with my doctors. I had a knee replacement surgery and thyroid cancer surgery unfortunately in the same year. No waiting for care at all. There are incompetent doctors and sadly your friends suffered from the doctors incompetence. Put blame where it belongs.

  • I wish the policy of allowing former employers to get waivers to enroll all their retirees in Medicare Advantage plans could be forbidden. Many retirees do not understand that Medicare Advantage plans not only threaten their financial security but often threaten their lives as well. (See Penny Hammack’s comment.). Both commercial Medicare Advantage plan providers and former employers push these plans, which provide questionable quality and access to medical care, on unsuspecting retirees with aggressive advertising because it makes money for the for-profit insurance company and saves money for the former employer. I think Medicare Advantage, which redirects a senior’s hard-earned Traditional Medicare benefit away from governmental oversight to a greedy, for-profit commercial insurance company is the most common and insidious form of elder fraud facing seniors today!

  • Republicans keep talking about how costly the Medicare program is and express a desire to cut it back. People making the choice between traditional Medicare and Medicare Advantage should understand that doctors and health care facilities who provide care through Medicare Advantage charge the Medicare program more that those who provide standard Medicare. A portion of the tax dollars that fund Medicare go not to health care but to the profits private insurance companies require in order to preserve their business model when you choose Medicare Advantage. Medicare, whatever its future in terms of whom and what they cover, should only cover patient needs and the small administrative cost to run the program. It’s an abuse of tax dollars to redirect them back to private company profits that fund huge executive pay and investor rewards. People should weigh the importance of preserving the program when making their choice.

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