RISE summarizes the latest headlines that impact Medicare, Medicaid, and Medicare Advantage (MA).

Pandemic drove huge spike in total national health care spending in 2020

COVID-19 caused a 9.7 percent increase in national health care spending, bringing spending to $4.1 trillion, according to the 2020 National Health Expenditures (NHE) Report, which was prepared by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).

Spending in response to the pandemic was primarily driven by increased federal spending, including financial assistance to providers to make up for lost revenue through the Provider Relief Fund ($122 billion in 2020) and the Paycheck Protection Program ($53 billion in 2020) and increased federal public health spending ($114.9 billion), including spending for vaccine development, COVID testing, and health facility preparedness. As a result, growth in federal government spending on health care increased 36 percent in 2020.

The report also identifies the areas of major payer spending in 2020:

  • Medicare spending totaled $829.5 billion in 2020, which represents 20 percent of total health care spending. Medicare spending increased in 2020 by 3.5 percent, compared to 6.9 percent growth in 2019. Fee-for-service expenditures declined 5.3 percent in 2020 down from growth of 2.1 percent in 2019. The decrease was largely attributable to a decline in expenditures for health care goods and services for the first time since 1999 because of the COVID-19 pandemic. Medicare private health plan spending grew 17.1 percent, an increase from the 15.3 percent growth in 2019.
  • Medicaid spending grew faster in 2020, increasing 9.2 percent to $671.2 billion compared to 3 percent growth in 2019, primarily driven by increased enrollment due to the pandemic. Medicaid hospital spending rose 6.7 percent in 2020, faster than in 2019, largely due to enrollment growth and increased Medicaid supplemental payments to hospitals, inpatient payments, and payments to mental health facilities.
  • Out-of-pocket spending declined by 3.7 percent in 2020 after a 4.4 percent increase in 2019. This decrease was driven by decreased use of health care and little or no cost-sharing requirements for COVID-19 testing and treatment in 2020.

OIG: Many Medicare beneficiaries don’t receive medication to treat opioid use disorder

Although nearly one million Medicare beneficiaries were diagnosed with opioid use disorder in 2020, less than 16 percent of them received the necessary medication to treat their disorder, according to a new report by the U.S. Department of Health and Human Services Office of Inspector General (OIG). The findings raise concerns that beneficiaries face challenges accessing treatment.

The report also found that less than half of the beneficiaries who received medication to treat their opioid use disorder also received behavioral therapy. These services may be provided in-person or via telehealth; however, the full extent to which beneficiaries use telehealth for behavioral therapy is unknown as Medicare does not require opioid treatment programs to report this information.

Other key findings from the report:

  • Medicare beneficiaries in Florida, Texas, Nevada, and Kansas were less likely to receive medication to treat their opioid use disorder than beneficiaries nationwide.
  • Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than white beneficiaries.
  • Older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder.

To help increase the number of Medicare beneficiaries receiving treatment, OIG recommends that the Centers for Medicare & Medicaid Services conduct additional outreach to beneficiaries to raise awareness about Medicare coverage for the treatment of opioid use disorder; take steps to increase the number of providers and opioid treatment programs for Medicare beneficiaries with opioid use disorder; create an action plan and take steps to address disparities in the treatment of opioid use disorder; and collect data on the use of telehealth in opioid treatment programs.

Study: More dual-eligible beneficiaries choose MA plans compared to FFS Medicare

The research, commissioned by the Better Medicare Alliance and conducted by ATI Advisory, finds that dual-eligible beneficiaries make up 23 percent of the total Medicare Advantage (MA) population compared to 17 percent in fee-for-service (FFS) Medicare only.

Dual-eligible beneficiaries–Medicare recipients who also qualify for Medicaid–have incomes near or below the Federal Poverty Level and often present complex medical and social needs and limitations. Researchers note that dual-eligible beneficiaries in MA experience better access to care compared to FFS Medicare. Indeed, the report found they are more likely to receive key preventive services including:

  • Mammograms (42 percent in MA, 34 percent in FFS Medicare)
  • Flu shots (68 percent in MA, 62 percent in FFS Medicare)
  • Blood cholesterol screenings (92 percent in MA, 84 percent in FFS Medicare)

The report, which was based on Medicare Current Beneficiary Survey data, also said that dual-eligible beneficiaries in MA report more chronic conditions than dual-eligible beneficiaries in FFS Medicare. Indeed, 72 percent of dual-eligible beneficiaries enrolled in a MA Special Needs Plan (SNP) report having three or more chronic conditions, as do 64 percent of dual-eligible beneficiaries enrolled in a non-SNP MA plan. By comparison, 56 percent of dual-eligible beneficiaries in FFS Medicare have three or more chronic conditions.

“This latest research is a powerful testament to Medicare Advantage’s capacity to meet the needs of an increasingly low-income, at-risk, and diverse population,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance, in an announcement“While dual-eligible beneficiaries in Medicare Advantage often present even more complex needs than their FFS Medicare counterparts, Medicare Advantage is nonetheless delivering better results in pairing beneficiaries with a usual source of care and providing them with needed preventive services. That is why dual-eligible beneficiaries today are more likely to enroll in Medicare Advantage than FFS Medicare. Now, policymakers must ensure this coverage lifeline for some of our most impoverished seniors remains protected.”