Regulators need to keep a close eye on Medicare Advantage insurers offering new supplemental benefits in the coming year, according to a health policy think tank.
The Bipartisan Budget Act, passed in February, contains numerous provisions meant to contain rising costs in Medicare while improving the quality of beneficiaries’ care. But for these policies to work as intended, the Department of Health and Human Services (HHS) must implement them carefully, according to an issue brief the Bipartisan Policy Center (BPC) released today.
Case in point: The act lets Medicare Advantage (MA) plans provide supplemental benefits for enrollees with chronic conditions. Patients with diabetes, for example, could have home-delivered meals that are low in sugar.
Insurers have been supportive of more flexible MA regulations, arguing the new law will allow them to build more comprehensive plans with attractive benefits. While that could improve care coordination, consumer advocates worry it could lead MA plans to engage in risk selection by building benefits that attract wealthier and healthier members.
Such benefits might include golf club or gym memberships.
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The brief also analyzes provisions to assist dual-eligible beneficiaries—those enrolled in both Medicare and Medicaid—who often suffer from multiple chronic conditions and cost a lot to cover.
On a press call, Katherine Hayes, director of health policy at BPC, pointed out that dual-eligible individuals may be juggling half a dozen plans, from medical services through Medicare and Medicaid plus a drug plan, long-term care, dental coverage and supplemental benefits. Expecting beneficiaries to navigate so many plans “is not realistic,” she said.
The brief recommends considering prior work done with the private sector to determine standards for Medicare-Medicaid integration, as well as states’ efforts to do so. Efforts to integrate the two programs in Washington and Massachusetts, for example, have saved a significant amount of money by reducing dual-eligibles’ hospital admissions.
BPC also recommends unifying the Medicare and Medicaid appeals processes; Hayes noted New York and Minnesota have already done so for their dual-eligible Special Needs Plans.
Although federal officials will need to unroll these provisions carefully going forward, Hayes said they contain considerable potential.
“They’re baby steps, but they’re steps nonetheless.”