Study: Medicare Advantage dual-eligibles less likely to miss care

Dual-eligible Medicare Advantage beneficiaries were less likely to experience care disruptions during the COVID-19 pandemic than dual-eligibles in traditional, fee-for-service Medicare, despite representing a more vulnerable patient population, according to a new study.

University of Chicago researchers analyzed more than 9,600 responses from a Medicare survey conducted from October to November 2020. They found 35% of Medicare Advantage dual-eligibles reported being unable to access a primary-care visit during the pandemic, compared with 51% of dual-eligibles enrolled in traditional Medicare, according to a study released on Tuesday. Dual-eligibles are individuals who qualify for Medicare and who also receive financial help and additional benefits from Medicaid.

Access to care during COVID-19 was particularly critical for Medicare Advantage dual-eligibles, since they represent one of the most vulnerable patient populations, said Mairin Mancino, a study researcher and senior director of healthcare strategy at NORC at the University of Chicago. Compared with traditional Medicare dual-eligibles, members who opted into Medicare Advantage plans were more likely to be older, more ethnically diverse and have chronic conditions—all placing them at a greater risk for contracting COVID-19. Additionally, nearly 40% of Medicare Advantage respondents said they spoke a language other than English at home, compared with 26% of traditional Medicare dual eligibles.

"I think there's a narrative out there that Medicare Advantage enrolls a healthy population and this study sheds light on the fact that those demographics today in 2021 look different than that prevailing narrative suggests," Mancino said.

In addition to reporting greater access to annual check-ups, Medicare Advantage dual-eligibles were also more likely than fee-for-service beneficiaries to report access to diagnostic testing, treatment for ongoing conditions and urgent care for emergencies during the pandemic. Five percent of Medicare Advantage members reported being unable to access urgent care during the pandemic, compared with 18% of traditional Medicare members; 24% of Medicare Advantage members said they were unable to get treatment for a chronic condition during the time period studied, compared with 36% of fee-for-service dual eligibles. And 28% of privately managed dual-eligibles reported they couldn't get a diagnostic screening or medical test, compared with 38% of traditional Medicare dual-eligibles.

Medicare Advantage dual-eligibles were also more likely to report access to services related to the social determinants of health than traditional Medicare beneficiaries, with more Medicare Advantage dual-eligibles saying they had greater access to nutritious food and financial resources than those in traditional Medicare. As members' deferred care led insurers to generate excess profits, many payers invested in benefits around the social determinants of health for members, rather than returning the excess cash to CMS.

Private payers also, in some cases, invested in providers' ability to connect with members virtually, reflecting a need to capture members' risk scores, a measure that essentially attempts to quantify how sick a patient will be. CMS pays Medicare Advantage insurers a set advance fee each month to cover the expected cost of enrollees' care based on these risk scores, which are derived from diagnosis codes submitted by the providers.

As the COVID-19 pandemic tore through the nation last spring and fall, Medicare Advantage members increasingly deferred care. During the fourth quarter of 2020, Humana, for example, reported a 15% drop in doctors visits among its Medicare Advantage enrollees. One way the Louisville, Ky.-based insurer aimed to promote access was to launch two Atlanta-area plans that paid for members' cellular data service to make sure they could connect with their providers virtually. SCAN Health Plan in California, meanwhile, set up a technology support line to teach Medicare Advantage members how to access their doctors electronically. NORC found increased connectivity for Medicare Advantage dual-eligibles across the industry.

The study said 63% of Medicare Advantage respondents said they accessed their provider virtually during COVID-19, compared with 52% traditional Medicare enrollees.

"As we see our healthcare system embracing value-based payments, it's really important to understand how a program like Medicare Advantage is meeting the needs of this vulnerable population, as compared to the fee-for-service population," Mancino said.

This study was sponsored by the America's Health Insurance Plans and conducted independently by researchers from NORC at the University of Chicago.