Dual Eligible Beneficiaries Prefer Medicare Advantage Over FFS

Dual eligible beneficiaries were more likely to choose a Medicare Advantage plan over a fee-for-service Medicare plan, a study commissioned by Better Medicare Alliance (BMA) found.

To understand the demographics, health outcomes, and healthcare spending trends among the dual eligible population, ATI Advisory analyzed data from the 2018 Medicare Current Beneficiary Survey and Cost Supplement File.

Researchers found that 44 percent of dual eligible beneficiaries were enrolled in Medicare Advantage compared to 35 percent who were enrolled in fee-for-service Medicare. Additionally, 23 percent of all Medicare Advantage members were dual eligibles whereas 17 percent of fee-for-service Medicare beneficiaries were dual eligibles.

Dual eligible beneficiaries who were enrolled in Medicare Advantage were more likely to have a usual source of care compared to beneficiaries enrolled in a fee-for-service Medicare plan, the report found. Medicare Advantage dual eligibles received preventive care services more often than fee-for-service dual eligibles as well.

In the past year, 42 percent of Medicare Advantage dual eligibles had a mammogram compared to 34 percent of fee-for-service dual eligibles.

Nearly 68 percent of Medicare Advantage dual eligible beneficiaries received a flu shot in the last year compared to 62 percent of dual eligibles on a fee-for-service Medicare plan. Medicare Advantage members were also more likely to have had their blood cholesterol measured than fee-for-service beneficiaries (92 percent and 84 percent, respectively).

The data revealed that dual eligibles in Medicare Advantage seemed to have an easier time accessing care compared to their fee-for-service counterparts. Only six percent of Medicare Advantage dual eligibles reported being unsatisfied with the ease of getting to the doctor, compared to 13 percent of fee-for-service beneficiaries.

Since dual eligible beneficiaries qualify for both Medicare and Medicaid, they typically have incomes that are near or below the federal poverty level. Dual eligibles are also more likely to identify as part of the Black or Latinx communities, compared to beneficiaries who are eligible for Medicare only.

Black beneficiaries and Latinx beneficiaries comprised more than half of all dual eligible beneficiaries enrolled in Medicare Advantage special needs plans (SNP), accounting for 29 percent and 27 percent of the overall dual eligible population respectively, the report noted.  

Just over 40 percent of dual eligibles in a Medicare Advantage plan without SNP identified as part of the Black or Latinx communities, with the percentage dropping to 34 percent among dual eligibles in fee-for-service Medicare. In contrast, only 13 percent of Medicare-only beneficiaries identified as Black or Latinx individuals. 

Dual eligible beneficiaries tend to have complex medical and social needs, another reason why they may flock toward Medicare Advantage instead of fee-for-service Medicare. Medicare Advantage and SNP can provide supplemental benefits that are tailored to members’ specific health conditions.

BMA found that 72 percent of dual eligible beneficiaries enrolled in a Medicare Advantage SNP reported having three or more chronic conditions compared to 56 percent of dual eligibles enrolled in fee-for-service Medicare. Th Medicare Advantage population without SNP fell in the middle, with 64 percent of dual eligible enrollees reporting 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,” Mary Beth Donahue, president and chief executive officer of BMA, said in a press release.

“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.”

In addition to more benefits, dual eligibles enrolled in Medicare Advantage saw lower healthcare costs than fee-for-service dual eligibles.

Dual eligibles in a Medicare Advantage SNP saw an average annual premium of $279 and dual eligibles in Medicare Advantage without SNP had a premium of $304. Meanwhile, fee-for-service dual eligibles saw an average annual premium of $435, the report revealed.

Dual eligible beneficiaries in Medicare Advantage saw lower average annual out-of-pocket costs as well, amounting to $1,112 for Medicare Advantage SNP beneficiaries, $1,960 for Medicare Advantage without SNP, and $2,647 for fee-for-service dual eligible beneficiaries.

“Policymakers should ensure the Medicare Advantage program is able to continue providing critical cost protections, targeted and high-touch care models, and supplemental benefits that are particularly meaningful to medically, functionally, and socially complex beneficiaries,” the report concluded.