Avalere: High needs of dual eligibles in MA highlight importance of alternative benefits

Medicare written on paper with a stethoscope
A new study compares the needs and service use of dual eligibles in Medicare Advantage to other beneficiaries. (Getty/Designer491)

Dual eligible Medicare Advantage (MA) beneficiaries are likely to struggle with complex health and social needs, which highlights the importance of making alternative benefits available, according to a new study. 

Researchers at Avalere analyzed a 2015 sample of 1.8 million MA members and found that nearly 60% of those eligible for both Medicare and Medicaid lived in areas where the median income was less than $30,000. 

More than half (55%) lived in neighborhoods where at least 20% of people lived below the federal poverty level, according to the study. 

In addition to these sociodemographic factors, the researchers found significantly higher rates of chronic illness in this population. Dual eligibles were 1.5 times more likely to have diabetes, 2.3 times more likely to be depressed and 2.4 times more likely to have Alzheimer’s disease or dementia, according to the study. 

RELATED: Medicare Advantage outperforms fee-for-service in cost, care for dual eligibles 

“I think that the key takeaways are really the magnitude of the difference between dual eligible beneficiaries and other Medicare Advantage beneficiaries,” Christie Teigland, Ph.D., principal at Avalere Health and one of the study’s authors, told FierceHealthcare. “These are big differences—these are not trivial.” 

As high-need beneficiaries, dual eligible MA members are using significantly more services, too, the study found. 

The dually eligible beneficiaries in the study made 2.8 times as many visits to the emergency department, used 2.2 times as many drug fills and had 1.8 times as many hospitalizations compared with non-dual beneficiaries. 

The dual eligibles in the study were also far more likely to be members of vulnerable groups—they were more likely to be female, young, disabled or an ethnic or racial minority, the study found. These beneficiaries were also more likely to live in high-cost urban areas. 

RELATED: CMS offers states chance to test new integrated care models for dual eligibles 

These findings are especially valuable to health plans, Teigland said, as the Centers for Medicare & Medicaid Services is allowing MA plan sponsors to offer more supplemental benefits to members.  

Insurers will need to craft a menu that is comprehensive but will also have to do the legwork to determine what services are most valuable to individuals, because they can’t feasibly offer all things to everyone. 

“I think it’s critical to understand which social determinants are most impacting your beneficiaries—they can’t provide every single nonmedical service to everybody,” Teigland said. “So for each member, to know exactly what factors are most impacting them is going to be important, because they’re going to have to prioritize.”