A recent analysis of Medicare data shows that the sickest (and most expensive) members of Medicare Advantage (MA) plans are dropping out of privately run MA insurance plans for traditional Medicare instead. I did.
A Wall Street Journal reporter analyzed Medicare data and found a pattern that is costing taxpayers billions of dollars. This pattern shows that Medicare Advantage’s sickest patients are canceling their coverage as their health needs and their medical costs rise, the article showed.
Perhaps more alarming, the article showed that many members of Medicare Advantage plans changed their plans after encountering problems with covering medical costs, the magazine said in an article.The most critically ill patients are fleeing private Medicare plans, costing taxpayers billions of dollars.” November 11, 2024.
Anna Wilde Matthews, Christopher Weaver, and Tom McGinty report that Medicare Advantage members are more likely to switch to traditional Medicare in their last year of life, shifting health care costs from their health insurance company to the federal government. He explained that he did.
As a result, MA insurers avoided a total of $10 billion in medical costs incurred by dropouts between 2016 and 2022, the reporters’ analysis showed.
“If these beneficiaries had stayed in the plan, the government would have paid insurance companies approximately $3.5 billion in premiums, meaning that insurance companies would have saved more than $6 billion over that period. “It will be,” they added.
Medicare Advantage plans, which health insurance companies sell to elderly and disabled Medicare members, are supposed to offer the same benefits members get from traditional Medicare, reporters explained. MA plans are appealing to seniors because they limit out-of-pocket costs and often offer additional benefits, such as dental care or gym memberships, they added.
“However, as beneficiaries become sicker, they may have a harder time accessing services than traditional Medicare enrollees,” Matthews, Weaver, and McGuinty wrote. “That’s because insurance companies actively control health care, by requiring patients to approve certain services and by restricting the hospitals and doctors patients can access.”
According to a WSJ analysis, from 2016 to 2022, seniors in their final year of life were twice as likely to transition from a Medicare Advantage plan to traditional Medicare as other enrollees. “Those who dropped out of private plans (300,75 people during that period) often ended up staying in hospitals or nursing homes for long periods of time after dropping out, resulting in large bills that taxpayers, not their original insurance companies, had to pay. His forehead is swollen,” the reporters explained.
Over the same period (from 2016 to 2022), seniors who dropped their Medicare Advantage plans cost the federal government an average of $218 a day, Matthews, Weaver and McGuinty wrote. “This is more than seven times the cost for a typical Medicare beneficiary and nearly twice the cost for the last year of life for other beneficiaries,” they added. They noted that the Journal’s analysis excludes hospice costs, which traditional Medicare typically covers for all patients.
In this report, KFF researchers detail why Medicare Advantage members switch to traditional Medicare.People who dropped out of Medicare Advantage spent 27% more on Medicare than similar people in traditional Medicare.”
