Highly integrated Medicare dual eligible special needs plans (D-SNPs) remain segregated in only certain parts of the country and aren’t as widely available as regular MA plans, a new report from a key Medicare advisory panel found.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on key Medicare policy and payment issues, released on Tuesday a lawmaker-mandated report (PDF) on how D-SNPs are performing amongst two other plan types: traditional MA plans and Medicare-Medicaid plans. D-SNPs are a type of MA plan that coordinates care for beneficiaries eligible on both Medicare and Medicaid.
“The results from this analysis are mixed—each plan type performed relatively well on some measures and relatively poorly on others—and do not clearly favor one plan type over the others,” the report said.
Researchers found most Medicare beneficiaries have access to an MA plan, and 94% live in a county with at least one D-SNP plan.
However, there is a wide geographic difference in enrollment in plans that are more highly integrated and not widely available.
In 2021, fully integrated care for dually eligible beneficiaries, which are plans that care for duals via a single managed care organization, were only available in 12 states. It also found that Medicare-Medicaid plans were available in nine states last year.
This variation means that there could be regional differences in access to care or physician practice patterns that could impact quality scores amongst the three plan types, the report said.
The data come as the Centers for Medicare & Medicaid Services have given MA plans flexibility to offer supplemental benefits to members in an effort to better address social determinants of health.
A 2019 study from the consulting firm Avalere found that nearly 60% of seniors eligible for Medicare and Medicaid live in areas with a low median income and face higher rates of chronic illnesses such as diabetes or Alzheimer’s disease.
MedPAC’s report also found that dual eligible beneficiaries could qualify for full benefits that include behavioral health or need long-term services and support such as managing medication or preparing meals.
Duals that have partial benefits tend to have better care and lower costs than full-benefit dual eligibles. MedPAC found that in 2020, partial-benefit dual eligibles made up 55% of the duals enrolled in MA plans but only 2% of enrollees in a fully integrated D-SNP.