Humana and several other insurers are pulling the plug by the end of the year on Medicare Advantage plans designed to serve people enrolled in both Medicare and Medicaid.
The plans, known as Dual Eligible Special Needs Plans (D-SNPs), were created by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Just this year they were reauthorized through 2018 by the Medicare Access and CHIP Reauthorization Act (MACRA).
By the end of the year, 16 such plans will no longer be offered, according to an analysis of federal data by the Integrated Care Resource Center, a consulting firm that works with the CMS and states on dual-eligible issues.
About 46,600 people are enrolled in the plans slated to end, and 70% of them are in plans offered by Humana. There are currently 1.7 million people enrolled in special-needs plans in 38 states.
The insurance companies say the closures reflect efforts to streamline their offerings to address low enrollment. For instance, one plan Humana is ending in Illinois has less than 50 members.
Other companies, such as the New York-based Independent Health, are ending plans that have struggled to turn a profit.
“Since offering the dual-eligible plan in 2013, we have struggled with its financial performance,” Frank Sava, a spokesman for the company. “Despite making significant benefit changes for 2015, the financial performance of the plan did not improve.”
Independent Health has been working with the 2,500 members to help them find other coverage.
Also complicating matters is that several states have launched demonstration programs under a provision of the Affordable Care Act aimed at providing better care at lower costs for the dual-eligible population.
Twelve states have rolled out three-year demonstrations under the effort so far. The plans in the participating in the demonstrations—called Medicare-Medicaid Plans—are able to more tightly coordinate the benefits and can passively enroll eligible beneficiaries.
In California, companies that offer both types of plans in counties where the demonstration is running must move eligible beneficiaries into the Medicare-Medicaid plan. As a result of the policy, Inland Empire Health Plan is shuttering a plan it says has less than 1,000 enrollees.
Most enrollees of terminated plans will have other options to enroll in an Medicare Advantage plan. There is no guarantee, however, that their preferred providers will contract with the new plan or that they would continue to receive any extra benefits provided under the special-needs plan, according to Judith Stein, executive director of the Center for Medicare Advocacy.