RISE summarizes the latest research news involving Medicare Advantage (MA) and the Affordable Care Act market.
JAMA study: Half of MA members leave plan after five years
A retrospective, cross-sectional study published in JAMA Health Forum found that half of MA beneficiaries disenrolled from their plan within five years between 2011 and 2020, with wide variation in five-year disenrollment at the contract level.
Researchers, led by David J. Meyers, Ph.D., MPH, department of health services, policy, and practice, Brown University School of Public Health, reviewed the Medicare Master Beneficiary Summary Final from January 1, 2011, to December 31, 2020, which included a record for each Medicare beneficiary each year and information on MA control and plan enrollment and beneficiary demographics. They also linked publicly available MA plan characteristics and Star rating files. To assess utilization, researchers linked to the Medicare Provider Analysis and Review file for hospitalization data, the Outcome and Assessment Information Set for home health visits, and the Minimum Data Set for nursing home stays.
The study found:
- After five years, 48.3 percent of nondually enrolled and 53.4 percent of dually enrolled MA beneficiaries were no longer enrolled in the same contract
- Black beneficiaries and those with greater comorbidity burden had higher five-year disenrollment rates from their MA plans
- There was substantial variation in five-year disenrollment across MA contracts, with only modest correlation with contracts’ one-year disenrollment rates
- Higher-rated contracts and vertically integrated contracts had substantially lower cumulative disenrollment rates
- Most disenrollment over time was to another MA contract rather than the traditional Medicare program
“As the MA program continues to grow, more attention may be needed to ensure that plans are adequately incentivized to take care of patients over time and to ensure that frequent disenrollments do not lead to disruptions in care,” researchers concluded.
HHS finds beneficiaries switching out of traditional Medicare drove MA growth
A new study published in Health Affairs examined the switching patterns between MA and traditional fee-for-service Medicare. Researchers from the Department of Health and Human Services (HHS) found that switching from traditional Medicare to MA more than tripled between 2006 and 2022, while switching from MA to fee-for-service Medicare decreased, with the change rates accelerating since 2019.
Research was based on the Centers for Medicare & Medicaid Services (CMS) Medicare Enrollment Database and the Risk Adjustment Processing System under data use agreements with CMS. Study authors used demographic, geographic, and enrollment information for all Medicare beneficiaries from the Medicare Enrollment Database. They identified beneficiaries who were newly enrolled in MA each year and classified beneficiaries as either newly eligible to enroll in Medicare or previously eligible. They then identified those who switched between fee-for-service/traditional Medicare and MA (“switchers”).
Among the findings:
- The share of switchers among all new MA enrollees rose from 61 percent in 2011 to 80 percent in 2022
- Black, dual-eligible, and disabled beneficiaries had higher odds of switching in both directions
- Younger and healthier beneficiaries were more likely to switch from traditional Medicare to MA but lower odds of switching from MA to fee-for-service Medicare
- Two-thirds of annual switching between MA and fee-for-service Medicare in 2022 occurred in January, likely reflecting the open enrollment period
Researchers said it appears younger and healthier beneficiaries were more likely to switch into MA, while older and sicker beneficiaries were more likely to switch out of MA and into fee-for-service Medicare. Individuals who switch to traditional Medicare have a broader range of providers and potentially avoid prior authorization and denials of care that have been recently documented by the HHS Office of Inspector General. Sicker beneficiaries might also enjoy greater flexibility in access to care in traditional Medica over the mitigation of financial risk in MA.
MA members with cancer spend less on health care than those in traditional Medicare
New research conducted by ATI Advisory and commissioned by the Better Medicare Alliance has found that cancer patients and survivors in MA spend on average over $2,000 less annually on out-of-pocket health care costs, are equally or more likely to receive preventative care services, and experience social disadvantage at higher rates than traditional Medicare beneficiaries.
The study includes a full quantitative analysis and a qualitative analysis.
Researchers used the 2019 Medicare Current Beneficiary Survey (MCBS) and Cost Supplement file and analyzed Part A and B Medicare claims for Medicare beneficiaries enrolled in FFS Medicare. Study authors examined how Medicare coverage arrangements are related to beneficiaries’ demographics, utilization of preventive care, and health care costs. All comparisons of MA and FFS Medicare were made using survey data from the same community-dwelling population except for personal cost data, which was collected from a subset of surveyed Medicare beneficiaries using a variety of self-reported and administrative sources.
Key findings from the research include:
- MA beneficiaries with cancer are demographically different and experience social disadvantage at higher rates than FFS Medicare beneficiaries.
- Among beneficiaries who received a cancer diagnosis, approximately half enrolled in MA have incomes below 200 percent of the Federal Poverty Level, compared to one third of FFS Medicare beneficiaries.
- Approximately one-fifth of MA beneficiaries with cancer or survivors experience food insecurity compared to 14 percent of FFS Medicare beneficiaries. MA beneficiaries are also more likely to identify as Black or Latino compared to FFS Medicare beneficiaries.
- MA members report similar or higher rates of preventive service use compared to FFS Medicare beneficiaries, and rates are highest among cancer survivors and patients.
- Medicare beneficiaries who have had a cancer diagnosis are more likely to be screened for cancer through a mammogram, colonoscopy, prostate blood exam, or fecal blood test than Medicare beneficiaries who have not been diagnosed with cancer.
- MA beneficiaries spend less on health care than FFS Medicare beneficiaries across cancer status.
- The difference between the two programs is slightly larger among cancer survivors and patients; MA beneficiaries who have cancer or are cancer survivors report spending on average $2,095 less on their health care than FFS Medicare beneficiaries.
“This study highlights how Medicare Advantage is working to improve outcomes for beneficiaries facing a cancer diagnosis by limiting the cost burden associated with cancer care and offering superior supplemental benefits such as in-home support services, meals, transportation and home-based palliative care for beneficiaries,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance, in the study announcement. “With the staggering cost of cancer care, patients deserve access to the affordable, high-quality health care and supplemental benefits offered by Medicare Advantage.”
KFF report: Already at record high, ACA marketplace enrollment could increase further
Enhanced marketplace subsidies have continued to drive up enrollment in the individual market, and the loss of Medicaid coverage by millions of people could contribute to this trend, according to a new KFF analysis. Meanwhile, enrollment in non-Affordable Care Act (ACA) compliant plans is at a record low.
The study finds that as of early 2023, an estimated 18.2 million people have individual market coverage, the highest since 2016. Individual market enrollment grew by about 29 percent between early 2020 and early 2023—a result of enhanced subsidies introduced by the Inflation Reduction Act, increased outreach, and an extended enrollment period.
This enrollment growth could continue in 2023 as states resume Medicaid disenrollments amid the unwinding of the continuous enrollment provision. Some of the people losing Medicaid coverage may be eligible for subsidies on the ACA marketplaces.
Due in part to the enhanced subsidies, about four in five individual market enrollees have subsidized coverage—the highest share since the ACA was implemented.
The number of people in non-compliant plans has fallen each year and could decrease further due to the Biden Administration’s proposed rule that would reverse the expansion of short-term plans. An estimated 1.2 million people were in non-ACA-compliant plans in mid-2022, compared to 5.7 million in mid-2015. These short-term plans often do not include certain benefits or coverage for pre-existing conditions and can impose a dollar limit on insurance coverage.
If unsubsidized premiums rise in 2024 due to higher health care prices and utilization, enhanced subsidies could shield most individual market enrollees from increases in their monthly payments.