Why are the Elderly Making a Switch in Medicare Coverage?

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A government report reveals a troubling pattern among Medicare enrollees in their last year of life.

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Seniors with Medicare Advantage plans are more than twice as likely to leave their plan and switch to traditional Medicare during their last year of life, a recent government analysis shows.

Money Talks News’ recent article entitled “Why Are Dying Seniors Switching Their Medicare Coverage?” explains that this switch may highlight potential issues with access to medical care or quality of care under Medicare Advantage plans, according to the U.S. Government Accountability Office (GAO), an independent federal agency. The higher rate of Medicare Advantage disenrollment among patients nearing death — who tend to need more care and costlier care — also leads to higher costs for the federal government, the federal agency discovered.

The agency’s findings are based on its analysis of Medicare disenrollment and mortality data for 2015 through 2018, which was the most current data available at the time. The GAO’s findings potentially have implications for individuals who are or who soon will be covered by Medicare.

Medicare Advantage plans are offered by private health insurance companies that contract with the federal government’s Medicare program. These plans most commonly are health maintenance organizations (HMOs), which make up 60% of Medicare Advantage plans in 2019, and preferred provider organizations (PPOs), which comprised 35% of those plans. The government pays these private insurers a fixed monthly amount for each person enrolled in their Medicare Advantage plans (a payment system known as capitation).

These payments are risk-adjusted, meaning the amounts are based on health status and demographic factors, such as age. As a result, Medicare Advantage payments are higher for older beneficiaries and those diagnosed with chronic conditions, like cancer and diabetes.

Therefore, if you are in poorer health than a typical senior, this may be something to look at when first enrolling in Medicare or during the next Medicare open enrollment period. Medicare Advantage plans have become increasingly popular in recent years because these plans typically offer enrollees lower costs and more benefits than Original Medicare.

However, to control enrollees’ utilization of services, Medicare Advantage plans may require referrals and prior authorization. The plans also tend to restrict enrollees to a particular network of health care providers. This can result in higher costs for enrollees, if they use out-of-network care.