MA plans see more minorities, dual eligibles signing up

By | October 17, 2020

Dive Brief:

  • While most Medicare beneficiaries are still enrolled in the traditional fee-for-service model, the number choosing a Medicare Advantage plan is growing rapidly. From 2013 to 2019, the number of people is MA grew 60% compared to a 5% increase in FFS enrollment, according to a new report commissioned by the Better Medicare Alliance, a coalition that includes privately-run plans like Aetna and UnitedHealth, but also patient and professional groups.
  • MA plans now have a higher percentage of people who are Hispanic, Black or Asian/Pacific Islander than traditional Medicare, according to their research. About 32% of MA members are among those groups versus about 21% of FFS, according to the report conducted by consulting firm Milliman.
  • The plans, dominated by payer giants like UnitedHealth, Humana and Blue Cross Blue Shield companies, have been lucrative for the sector, though have come under some criticism and accusations of overcharging the government.

Dive Insight:

The COVID-19 pandemic has further exposed existing racial and social disparities rampant in the U.S. healthcare system, putting pressure on providers and payers to focus more on equality in care delivery.

MA plans have made some effort to address social determinants of health with flexibilities from CMS in recent years for unique benefits that target needs for transportation, housing stability and food access among others.

“Many of the plans know this and they’re being very attentive to the changes they can make to address health equity,” Better Medicare Alliance CEO Allyson Schwartz said.

The MA program has a higher share of beneficiaries who are between 70 and 84 (52% versus 46%) while FFS Medicare has a higher share between 65 and 69 (29% versus 24%), according to the Milliman report.

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The MA program is also grabbing a higher share of people who are also eligible for Medicaid in recent years — from a quarter of all dual eligibles in MA in 2013 to 44% last year.

The researchers cautioned that, however that there are some shortcomings in the data, particularly in racial/ethnic identification.

The plans have come under some criticism, in particular for overcharging the government for members. A federal watchdog earlier this year found Medicare Advantage health plans billed the federal government $ 2.6 billion in 2016 for more than 617,000 patients whose risk-adjusted medical conditions were diagnosed without their physician present, the report from the HHS Office of the Inspector General concludes.

In August, the Department of Justice alleged that CMS overpaid Cigna an estimated $ 1.4 billion from 2012 to 2017 because the payer falsified health conditions.

Anthem and UnitedHealth have also been accused by DOJ with inflating plan member conditions to boost payments from CMS.

Schwartz on Thursday advocated for a revamp of the Medicare enrollment process, including sending information to future beneficiaries when they turn 64 instead of three months before their 65th birthday and better tailoring the experience to individual medical needs and patient characteristics. Supporting materials should be available in more languages than just English and Spanish, she said.

The former Democratic lawmaker also suggested the entire process be administered by HHS instead of starting with the U.S. Social Security Administration.

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