Medicare Advantage Dual Eligibles Have Better Access to Care

Medicare Advantage dual eligibles reported better access to care and access to telehealth during the coronavirus pandemic than traditional Medicare beneficiaries did, a report from NORC at the University of Chicago found.

The researchers leveraged data from the Medicare Current Beneficiary Survey (MCBS) COVID-19 Fall 2020 Supplement Public Use File (PUF).

Dual eligibles who were enrolled in Medicare Advantage plans and also received coverage through Medicaid tended to be higher risk than beneficiaries who were enrolled in traditional Medicare: they were older, faced more chronic conditions, and were more likely to identify as part of the Black or Hispanic communities.

“In recent years, Medicare Advantage plans have increasingly enrolled more complex and medically frail members,” Mairin Mancino, senior director of Health Care Strategy at NORC, said in the press release. “Older adults with higher medical needs can benefit greatly from improved care management and coordination of services that Medicare Advantage plans provide.”

Nearly six in ten Medicare Advantage dual eligible individuals (56 percent) reported having four or more chronic conditions, compared to about five in ten beneficiaries in traditional, fee-for-service Medicare (46 percent).

However, traditional Medicare beneficiaries had a slightly higher rate of living with weakened immune systems and were more likely to be current smokers.

Furthermore, Medicare Advantage dual eligible enrollees were more likely to have trouble accessing food and had a harder time affording their mortgage or rent payments. 

Five percent of Medicare Advantage dual eligible enrollees said that they could not receive the food that they wanted, compared to 4.5 percent of traditional Medicare, dual eligible beneficiaries. 

Meanwhile, 5.7 percent of Medicare Advantage dual eligible enrollees reported that they were unable to pay for their housing as opposed to 3.7 percent of traditional Medicare dual eligible beneficiaries.

Despite these risk factors, Medicare Advantage dual eligible enrollees reported lower barriers in access to care and higher access to telehealth.

Slightly more than half of traditional Medicare dual eligible beneficiaries reported that they had to skip their regular check up in 2020. In contrast, a little over a third of Medicare Advantage dual eligible enrollees said the same.

That year, diagnostics or medical screenings, treatments for an ongoing condition, and urgent care services were all substantially more difficult to access for traditional Medicare dual eligible beneficiaries than their counterparts in Medicare Advantage.

Additionally, while the share of individuals who reported having access to telemedicine was similar between traditional Medicare and Medicare Advantage dual eligibles before the coronavirus pandemic, the trend took a turn in 2020. 

A little over half of traditional Medicare dual eligibles reported having access during the pandemic (52 percent), compared to nearly two-thirds of Medicare Advantage dual eligibles (63 percent).

“Medicare Advantage dual eligibles experienced fewer disruptions in care during the pandemic, which may be the result of added care coordination and outreach from their health plans,” Caroline Pearson, senior vice president at NORC at the University of Chicago, shared in the press release. 

“Older adults often select Medicare Advantage plans due to expanded benefits and lower out-of-pocket costs. But especially during a pandemic, navigation and care coordination services are critical to help close gaps in care.”

These results may not be entirely surprising in light of Humana’s recent Bold Goal results. The Bold Goal report found that Humana’s Medicare Advantage community that received more robust social determinants of health support displayed fewer unhealthy days than Humana’s Medicare Advantage communities outside of the Bold Goal program.

The report also identified a 2.7 percent decrease in unhealthy days in the Medicare Advantage community overall from 2015 through 2020.

CMS flexibilities for addressing social determinants of health may play a role in giving Medicare Advantage health outcomes the edge over traditional Medicare.

Dual eligibles face unique challenges and this predicament of how to provide consistent coverage has led to a couple of unique proposals.

MACPAC introduced the idea of an integrated dual eligible program in March 2021. The concept would require integration across eligibility, beneficiary protections and enrollment, benefits, and other facets of care and coverage.

The Government Accountability Office expounded on the advantages of aligned enrollment for dual eligibles but also stressed the need for greater CMS oversight in this area.

As payers and policymakers continue to search for better strategies around dual eligible care and coverage, research like NORC’s helps highlight the successful strategies seen in Medicare Advantage plans.