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Tag: Long-term

  • Medicare Advantage plans have little reason to address people’s long-term health needs

    Medicare Advantage plans have little reason to address people’s long-term health needs

    Nearly half of all Medicare Advantage members leave their Medicare Advantage plans within five years of enrolling, according to a recent study by David Meyers et al. at the Brown University School of Public Health published in the JAMA Network. Most of them are locked out of traditional Medicare because they are unable to get supplemental coverage, so they switch to other Medicare Advantage plans. Because insurers offering Medicare Advantage plans know they are not likely to hold on to their members over the long-term, they have little reason to address people’s long-term health care needs.

    The government pays Medicare Advantage (MA) plans a fixed rate per enrollee, regardless of the amount of money the MA plans spend on each enrollee. The thought is that these generous payments would lead the insurers offering MA plans to invest in the long-term heath and care outcomes of their members. But, the data suggests otherwise. The researchers suggest that their findings provide a strong reason for looking at long-term MA disenrollment rates when measuring MA performance as a means of helping to ensure MA plans do not disregard their members’ long-term health care needs.

    Researchers studied 82 377 917 individuals enrolled in a Medicare Advantage plan any time from 2011 to 2020. Of those, overall, nearly half (48 percent) left their MA plan within five years of joining. One-third left their MA plan within three years of joining. Disenrollment rates varied substantially by Medicare Advantage plan.

    These findings adds support to the case that Medicare Advantage plans are likely not invested in the long-term health and care management of their members, as hoped. Data on inappropriate denial rates in Medicare Advantage, particularly for people in hospital and people in need of post-hospital care also suggests that Medicare Advantage plans, as a whole, have little or no interest in ensuring the health and well-being of their members. Rather, the denial data suggests that once their members get sick and need costly care, the MA plans want them to leave.

    The researchers at Brown have found that people enrolled in Medicare Advantage plans who have complex and costly needs disenroll from their plans at higher frequency than people who are in relatively good health. Now, these researchers find that, over time, half of people disenroll from their Medicare Advantage plans. The researchers did not study why, but there’s a compelling argument that these people disenrolled because they were dissatisfied with their plans.

    The researchers further found that Black Medicare Advantage enrollees disenrolled from their Medicare Advantage plans at higher rates than enrollees of other races. Nearly 15 percent of them disenrolled from their Medicare Advantage plans within one year of enrolling.

    Of note, a smaller portion of people enrolled in plans with five-star ratings disenrolled within five years as people enrolled in four- and three-star plans.

    In sum, the researchers report three key findings from their work, in addition to their finding that 48.3 percent of people enrolled in Medicare Advantage plans who do not also have Medicaid left their Medicare Advantage plans within five years.

    1. Black enrollees in Medicare Advantage left their Medicare Advantage plans at higher rates than people of other races.
    2. Different Medicare Advantage plans had very different rates of disenrollment, though the researchers do not disclose which Medicare Advantage plans have the highest disenrollment rates over the five-year period. Disenrollment rates over one year did not correlate with disenrollment rates over five years.
    3. Medicare Advantage plans with five stars had lower disenrollment rates than those with fewer stars.

    The researchers conclude that Medicare Advantage plans “may financially benefit by increasing coding intensity in a short period while avoiding interventions to address chronic conditions in which potential benefits may take time to materialize and accrue to competing insurers.”

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  • As population ages, need for more caregivers

    As population ages, need for more caregivers

    Today, about one in 12 people over 20, nearly 18 million people, provide care for an older family member with health issues. A new report, Families Caring for an Aging America, by the National Academy of Sciences, Engineering and Medicine, finds that by 2030, as our population ages, there will be a need for more caregivers. Will we have systems in place to support these caregivers and permit them to continue to meet the needs of older adults?

    By 2030, more than 70 million Americans will be over 65– about 20 percent of the population.  And, they will continue to need help with long-term care services and supports. But, the pool of  caregivers is shrinking as an increasing number of older adults are childless, single or live far from their children. Moreover, more women than ever are working, depend on that income, and do not have the flexibility to juggle work, kids, and caregiving for the older adults in their lives.

    While many family caregivers of older adults report tremendous benefits from caregiving, they are also more prone to depression, anxiety and stress than non-family caregivers. They are more likely to suffer from chronic conditions. And, they are prone to economic hardship. Half of all caregivers spend more than five years delivering care to an older adult. For caregivers over 50, lost work income and benefits are estimated to be $303,880, and that does not include lower Social Security benefits.

    The report assesses the needs of family caregivers looking after older adults and how well they are supported today. It further considers how new policies could better serve these family caregivers.

    Sixteen years ago, Congress created the National Family Caregiver Support Program, under the Administration on Aging, which explicitly addresses the needs of people caring for older adults. The NFCSP provides information, assistance in securing services, individual counseling for caregivers as well as education and support groups, respite services and supplemental services. All caregivers over 60 are eligible as well as caregivers caring for people over 60. However, Congress only appropriated $150 million for services

    What’s crystal clear is that Congress needs to allocate more resources to better support caregivers and older adults in their communities. New programs and services must be developed that are accessible and affordable. You can support family caregivers by clicking here.

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