Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types

Area of Science:

• Health Services Research
• Gerontology
• Health Policy

Background:

• A growing number of individuals eligible for both Medicare and full Medicaid benefits are enrolling in Medicare Advantage (MA) plans.
• Medicare Advantage plans differ in their capacity and incentives for coordinating Medicare and Medicaid services.
• Limited information exists on the characteristics of dual-eligible beneficiaries across various MA plan types.

Purpose of the Study:

• To compare the health and demographic characteristics of full-benefit dual-eligible beneficiaries across four distinct MA plan types.
• To examine variations in Medicare-Medicaid service coordination and spending requirements among these MA plan types.

Main Methods:

• Cross-sectional study utilizing Medicare Health Outcomes Survey (HOS) data from 2017-2019.
• Included 147,923 full-benefit dual-eligible beneficiaries enrolled in MA.
• Analyzed beneficiary demographics, comorbidities, functional status, living arrangements, and socioeconomic factors across standard MA, coordination-only D-SNPs, D-SNP look-alikes, and FIDE-SNPs.

Main Results:

• Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) enrolled a higher proportion of beneficiaries aged 85+, those living with caregivers, and individuals with more comorbidities and functional limitations.
• Beneficiaries in FIDE-SNPs and coordination-only D-SNPs exhibited greater health burdens compared to those in standard MA or D-SNP look-alike plans.
• Enrollment patterns in FIDE-SNPs and coordination-only D-SNPs showed concentration in areas with high socioeconomic disadvantage, suggesting potential disparities in access or plan design.

Conclusions:

• Significant health disparities exist among full-benefit dual-eligible beneficiaries across different Medicare Advantage plan types.
• FIDE-SNPs appear to enroll the most vulnerable dual-eligible populations, highlighting their role in managing complex care needs.
• Findings underscore the necessity for tailored interventions and further research into MA plan selection and care coordination for this population.