eridani
eridani's JournalHigh-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining--
--Traditional Medicare
We examined the relationship between use of hospital, nursing home, and home health care in 2010 and beneficiaries’ switching between Medicare Advantage and traditional Medicare by January 2011. Among traditional Medicare beneficiaries, we observed lower rates of switching into Medicare Advantage among people who used nursing home, home health, or acute inpatient care, compared with beneficiaries who did not use these services. In contrast, among Medicare Advantage beneficiaries, we found increased rates of switching into traditional Medicare among people who used nursing home and home health care, compared with beneficiaries who did not use these services.
Our results are consistent with other studies reporting that beneficiaries who report poorer health, use more health services, and have higher health care spending are more likely than their counterpart Medicare Advantage beneficiaries to leave Medicare Advantage plans, despite the recent reforms to the Medicare Advantage payment formula.
Comment by Don McCanne of PNHP: In 1997, The New England Journal of Medicine published a landmark article that showed that Medicare patients who enrolled in private Medicare HMOs exited them when they developed a need for a greater amount of health care: “The Medicare-HMO Revolving Door — The Healthy Go in and the Sick Go Out”
After nearly two decades of refinement of payment methods for the private Medicare Advantage plans, this new study from Health Affairs shows that “a high proportion of beneficiaries with nursing home or home health care use choose to exit the Medicare Advantage program.” Specifically, “Our results are consistent with other studies reporting that beneficiaries who report poorer health, use more health services, and have higher health care spending are more likely than their counterpart Medicare Advantage beneficiaries to leave Medicare Advantage plans, despite the recent reforms to the Medicare Advantage payment formula.”
The healthy go in and the sick go out. With Medicare Advantage plans, the patients and the taxpayers end up as losers.
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70 National Organizations Urge Congress to Act on 2016 Part B Premium and Deductible Hikes
This week, led by Medicare Rights Center, 70 prominent organizations representing people with Medicare, health insurers, workers, federal employees, and more sent a letter to key Congressional committees urging swift action to shield older adults, people with disabilities, and state Medicaid programs from anticipated increases in Medicare Part B premiums and the Part B deductible in 2016.
Part B costs are expected to increase next year for 30 percent of people with Medicare. Without a fix, Part B premiums will increase to $159 per month for select beneficiaries, and the Part B deductible will rise to $223 for all people with Medicare. Older adults and people with disabilities affected by the projected premium increase include new Medicare enrollees, individuals not collecting Social Security benefits, beneficiaries already paying higher premiums, and people with both Medicare and Medicaid (state Medicaid programs will bear this cost). The anticipated hike in the Part B deductible will impact all beneficiaries, most significantly affecting those who lack adequate supplemental coverage.
Joe Baker, President of Medicare Rights, said in a written statement, "Older adults and people with disabilities cannot shoulder these unprecedented increases, especially those living on low- and fixed incomes. Half of all people with Medicare are living on annual incomes of $24,150 or less. We urge members of Congress to heed this call to action from leading voices across the health care sector.”
Read the letter.
http://medicarerights.org/pdf/093015-joint-ltr-partb-premiums.pdf
Read Medicare Rights' statement.
http://www.medicarerights.org/newsroom/press-releases/93015-2
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