Dual Eligible Medicare Advantage Patients Report Fewer Disruptions in Care vs Traditional Medicare During COVID

Dual Eligible Medicare - How it Works 

The term dual eligible or the dual eligible definition refers to low-income seniors or individuals with disabilities who qualify for benefits under both the Medicare program and their state Medicaid program. The dual eligible Medicare population is diverse with many beneficiaries carrying multiple chronic illnesses, different forms of cognitive impairment, mental illnesses, and disabilities both physical and developmental. Dual eligible patients are more likely to have functional limitations and require long-term care services than non dual eligible Medicare beneficiaries. A thorough range of medical and support services is typically required for this highly complex population.

Medicare Advantage (MA) plans ensure that affordability is not an obstacle to care for low-income individuals by offering options to reduce out-of-pocket costs, which is particularly important for dual eligible Medicare beneficiaries who typically receive only partial financial support for their Medicare benefits. Medicare Advantage plan activities that detect, treat, and prevent the progression of chronic disease have proven to have positive effects that are improving care and reducing costs throughout the Medicare program. Research has also shown health plans have put programs in place that are improving the lives of Medicare Advantage dual eligible patients, who stand to benefit the most from the delivery of coordinated care that’s patient centered and focused on prevention.

Dual Eligibles: By the Numbers

Dual Eligible Patients During the Pandemic 

According to analysis from NORC at the University of Chicago, Medicare Advantage dual eligible beneficiaries reported lower barriers in access to care during the coronavirus pandemic than traditional dual eligible Medicare beneficiaries. Among beneficiaries reporting lapses in care in 2020, only 35 percent of Medicare Advantage dual eligibles said they were unable to get a regular check-up during the pandemic, compared to 51 percent in fee-for-service (FFS). Similarly, Medicare Advantage dual eligibles were less likely to report that they were unable to get treatment for ongoing conditions, medical screening tests, urgent care for accidents or illnesses during the pandemic.

Before the coronavirus pandemic the population of beneficiaries who reported having access to telehealth services was basically even between traditional Medicare and Medicare Advantage dual eligibles. But in 2020 the previously even split widened with over half of traditional dual eligible Medicare patients reported having access during the pandemic (52 percent), compared to nearly two-thirds of Medicare Advantage dual eligibles (63 percent).

According to experts at NORC at the University of Chicago, dual eligible patients are some of the most complex and vulnerable seniors. Furthermore, the individual who qualifies for dual eligible and choses to enroll in MA tends to be older, sicker, and more racially and ethnically diverse than their dual eligible equivalents in the traditional FFS Medicare program. Medicare Advantage dual eligible patients are more likely to be black or hispanic and speak a language other than english at home. Additionally, 56 percent of dual eligible patients who chose Medicare Advantage have four or more chronic conditions, compared to only 47 percent of those in FFS. Twenty six percent of dual eligible Medicare Advantage patients are age 75 or older, compared to 18 percent of dual eligibles enrolled in FFS. Despite being older and sicker, dual eligible patients in Medicare Advantage were less likely to report hardship accessing care during the COVID-19 pandemic.

Often older adults choose Medicare Advantage plans due to expanded benefits and lower-out-of pocket costs. In recent years, Medicare Advantage enrollment has grown and plans have increasingly enrolled more complex and medically frail members. Elderly adults with increased medical needs can benefit the most from better-quality care management and the coordination of services Medicare Advantage plans provide. The added care coordination and outreach from Medicare Advantage health plans during the pandemic may have contributed to the decrease in disruptions in care which is critical to help close gaps in care, especially during a pandemic.

 It’s always important to comprehensively document the disease burden of your Medicare Advantage population and with dual eligible patients, because of their complexity, it is paramount. Resource scarcity is common in dual eligible populations and a mismatch between disease burden and reimbursement may negatively impact the health of that cohort. ForeSee Medical risk adjustment software uses AI tools such as natural language processing (NLP) to assist providers and coders in reporting dual eligible HCC related ICD10 codes thereby facilitating accurate compensation. We suggest that medical groups that provide care to Medicare Advantage members use software that includes NLP to code with greater precision and it is especially true when caring for a dual eligible population.

Blog by: The ForeSee Medical Team