High-cost seniors turn to traditional Medicare over Medicare Advantage plans

By Annette M. Boyle

Many seniors switch from Medicare Advantage plans to traditional Medicare when they become seriously ill, which raises questions about how well MA plans can serve this population of high-cost patients, according to a new Health Affairs study.

Researchers found that 17 percent of participants who used long-term nursing home care switched from MA plans to traditional Medicare between 2010 and 2011, almost six times the rate of those who decided to move from traditional Medicare to a private MA plan.

"The unidirectional flow of these high-risk and often high-spending patients from Medicare Advantage to traditional Medicare appears to transfer responsibility to traditional Medicare just as patients enter a period of intensive healthcare needs," the authors write.

There may be various reasons for these trends, the study notes. MA plans may not be experienced in delivering post-acute and long-term care, or may lack sufficient incentives to spend their enhanced payments on better services for beneficiaries. Additionally, MA members who use home health or nursing home services may not be satisfied with their program due to network restrictions, and many MA plans impose high cost-sharing on members for long-term care, the authors write.

These findings come as Medicare Advantage programs rise in popularity. A recent study also indicated that many MA members have a choice between an average of 18 plans.

Still, the program has been criticized for inefficiency, with a recent government audit revealing millions in overpayments.

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