Man on wheelchair, talking with woman

Medicare Advantage — the private form of Medicare — has long been criticized for selectively enrolling healthier people to its managed care plans. But a new study that examined evidence of barriers to access finds that it is now holding onto more patients who are sick and who have complex health needs, researchers report.

“Twenty or 30 years ago, it used to be that people who develop chronic conditions switched back to traditional Medicare like crazy, but in our study, the switch-back rate was very low,” researcher Wendy Xu, PhD, of The Ohio State University’s College of Public Health said in a statement.

Xu and colleagues analyzed Medicare data from nearly 45,000 people who enrolled between 2009 and 2019, when MA plan enrollment was growing quickly. The goal was to see whether MA enrollees with chronic conditions were more likely to disenroll over that 10-year period. Switching was defined as enrollment in MA one year and Medicare fee-for-service enrollment the following year, or vice versa.

No more likely to disenroll

Investigators found that seniors with chronic conditions were not more likely than their healthier peers to disenroll from their MA plans during the study period. 

There is no longer a clear incentive for providers to skimp on health services as there was in the original MA model, reducing beneficiaries’ need to switch, the researchers explained. The Medicare program now incentivizes the enrollment of a larger proportion of lower-income and minority groups, and people with multiple chronic conditions, they said.

Barriers for the dually eligible

Yet, the most vulnerable Americans may continue to lack access to MA plans, the study also found. Low-income older Americans who are dually eligible for Medicare and Medicaid tend to have a higher rate of switching from Medicare Advantage to traditional Medicare than non-dual-eligible enrollees, the authors reported.

“[Medicare Advantage] plans appear to serve older Americans reasonably well based on our study,” lead author Eli Raver, a doctoral student at The Ohio State University College of Public Health said. “But for those with multiple chronic conditions who are also poor, and for those with disabilities, there could be some concerns about whether Medicare Advantage is providing enough access to care.”

About half of Medicare beneficiaries are enrolled in Medicare Advantage plans, and the percentage is rising, Xu said.

Full findings were published in JAMA.

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