More Medicare Beneficiaries with COPD Enrolled in FFS Than MA

The majority of Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) are enrolled in fee-for-service Medicare, but the share of beneficiaries in Medicare Advantage plans is projected to increase over the next 10 years, according to research from Avalere.

COPD can lead to health complications or death if individuals do not receive proper care and medication. The disease is also more common in adults 65 years or older compared to younger adults, making it a priority for the Medicare program.

Avalere analyzed Medicare fee-for-service and Medicare Advantage claims from 2015 to 2019 to understand which beneficiaries experience COPD the most.

In 2019, 11 percent of all Medicare beneficiaries (6.15 million) had COPD. More than half of those beneficiaries (60 percent) were enrolled in fee-for-service Medicare, while 40 percent were in a Medicare Advantage plan, according to the study.

The share of Medicare Advantage beneficiaries with COPD has been on the rise since 2015 when it was 32 percent. As of 2019, the percentage of Medicare Advantage beneficiaries with COPD is 40 percent. This percentage is expected to grow by 3.1 percent by 2030, researchers said.

Additionally, in 2018 and 2019, there was a higher percentage of Medicare beneficiaries with COPD enrolled in a Medicare Advantage plan (38 and 40 percent, respectively) compared to the share of overall Medicare beneficiaries in Medicare Advantage (35 and 36 percent, respectively).

The Medicare Advantage population with COPD in 2019 was also younger than the fee-for-service population with COPD, researchers found. Nearly 25 percent of Medicare Advantage beneficiaries with COPD were younger than 65, compared to 21 percent of fee-for-service beneficiaries.

Meanwhile, more fee-for-service beneficiaries with COPD were 76 years old or older compared to the Medicare Advantage population.

However, compared to the overall Medicare Advantage population, more Medicare Advantage beneficiaries with COPD were 76 years of age or older (34 percent versus 29 percent, respectively). Similarly, a larger share of fee-for-service beneficiaries with COPD was older than 75 compared to the overall fee-for-service population (39 percent versus 35 percent).

This data backs up Avalare’s claim that older individuals are more likely to have COPD.

Recently, fee-for-service beneficiaries with COPD have been switching to Medicare Advantage at higher rates. In 2015, three percent of fee-for-service beneficiaries with COPD switched to a Medicare Advantage plan, growing to seven percent in 2019. For the overall fee-for-service population, this figure increased from 3 percent in 2015 to five percent in 2019.

Beneficiaries may choose to switch to or enroll in Medicare Advantage because of the cost benefits that Medicare Advantage plans offer.

For example, beneficiaries with COPD in Medicare Advantage plans will have an annual limit on out-of-pocket spending for Part A and Part B services because of Medicare Advantage’s out-of-pocket spending maximum. In addition, many Medicare Advantage plans may include benefits that specifically address chronic disease management.

Fee-for-service beneficiaries do not have an out-of-pocket spending cap and many tend to have some form of supplemental coverage to help with cost-sharing, such as Medicaid, Medigap, employer-sponsored coverage, or Tricare.

Fee-for-service beneficiaries with COPD were more likely to be dual eligible beneficiaries compared to the overall fee-for-service population, Avalere found. Nearly 30 percent of COPD beneficiaries had Medicaid or public coverage in addition to fee-for-service coverage, compared to 18 percent of the overall general Medicare population.

Dual eligible beneficiaries typically have lower incomes, more health issues, and usually qualify for Medicaid through disability benefits, Avalere stated. This suggests that beneficiaries with COPD tend to have lower incomes compared to the general fee-for-service population.

On the other hand, beneficiaries in the overall fee-for-service population were more likely to have employer-sponsored supplemental coverage compared to beneficiaries with COPD (34 percent versus 25 percent).

Nearly 30 percent of both beneficiary populations had Medigap for supplemental coverage. In addition, the share of beneficiaries who had no supplemental coverage was similar for beneficiaries with COPD and the overall fee-for-service population (10 percent versus 12 percent).

Healthcare costs, benefits, and outcomes may differ depending on if a beneficiary is enrolled in fee-for-service Medicare or Medicare Advantage. Currently, more beneficiaries with COPD are enrolled in fee-for-service, but the percentage of beneficiaries in Medicare Advantage continues to grow.