Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability

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    • #312767
      eridani
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      • Total Posts: 10,151

      https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01070

      This nationally representative study of adults ages sixty-five and older demonstrated that people are more likely to switch from Medicare Advantage to traditional Medicare following the onset of disability than from traditional Medicare to Medicare Advantage, and that the characteristics of people who switch from Medicare Advantage to traditional Medicare are different from those of people switching from traditional Medicare to Medicare Advantage. While other studies have demonstrated that high-need older adults are more likely to switch from Medicare Advantage to traditional Medicare than the reverse, this is the first study to show the temporal relationship between onset of disability and disenrollment from Medicare Advantage. Furthermore, older adults who are of nonwhite race or from high-risk socioeconomic groups are more likely to switch insurance coverage than are those of white race and with higher incomes and education levels, while those who are more severely disabled are more likely to prefer traditional Medicare. These findings have important implications for measuring quality, appropriately risk-adjusting payments, and reducing disparities within the MA program.

      In 2017 the Government Accountability Office conducted an assessment of MA plans with high levels of beneficiaries’ switching to traditional Medicare, using claims to estimate the health status of individuals who switched plans. Consistent with our results, the assessment found significant levels of health bias, or higher rates of disenrollment by individuals in poor health.

      Comment by Don McCanne of PNHP:  Even though Congress and both Republican and Democratic administrations have continued to advance policies favoring the private Medicare Advantage plans while neglecting the traditional Medicare program, the private insurance industry continues to demonstrate what a bad deal the taxpayers are receiving from their plans (though acknowledging that healthier beneficiaries are often satisfied with their care).

      This study shows that people who develop functional disabilities tend to disenroll from the private Medicare Advantage plans and move into the traditional Medicare program. This is particularly true of nonwhite individuals from high-risk socioeconomic groups who were in poorer health, including those with more severe disabilities.

      As our politicians continue in their efforts to privatize Medicare, it is working superbly well for the Wall Street investors who are choosing insurance stocks, but privatization is not serving well Medicare beneficiaries who have the greatest health care needs. Instead, our politicians should improve the traditional Medicare program, while eliminating the private sector that has brought us higher costs and lower quality (the opposite of what they promised). Then we should expand Medicare to cover everyone through an efficient, effective and more equitable single payer model of Medicare for All. The sooner the better.

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #312791
      gordyfl
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      • Total Posts: 1,842

      So true. I knew a couple of people who tried to switch from Medicare Advantage to Original Medicare. They were in their mid 70s and their out of pocket medical bills were increasing. The problem they had was getting a supplemental plan. The private insurance companies were denying them (with no explanation), or were charging them premiums they could not afford. This was all part of the insurance companies’ game plan in maximizing profits. Move the older less healthy onto the government program. That’s what I believe the Public Option will be used for – to push the less healthy employees onto the government Public Option, while healthy employees stay with the private plan provided by their employer. It’s a way of escaping the “pre-existing clause.

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