Thursday, July 6, 2017

Sicker Medicare Beneficiaries and Original Medicare

NPR recently ran a story about beneficiaries enrolled in Medicare Advantage plans. As Seniors Get Sicker, They're More Likely To Drop Medicare Advantage Plans  discusses a recent "GAO report, released this spring, [that] reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care as the leading reasons for leaving." The article notes the positives to MA plans, but also some concerns: "some critics argue the plans can prove risky for seniors in poor or declining health, or those ... who need to see specialists, because they often face hurdles getting access." The GAO report referenced in the story is available here.

Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink


I make this comment without having read the article cited in this post. I believe the movement from a Medicare Advantage plan into traditional (original) Medicare (often with a supplement) when the participant is in a downward spiral health-wise has at least two major reasons: first, an adult child of an elderly person may want to relocate Mom or Pop (or both) to be closer to said child geographically. Upon the relocation, one just doesn’t want the hassles of finding the permitted networks of doctors, therapists, pharmacists …. just locating those providers that take Medicare is effort enough. Second, even if there isn’t a geographic relocation there may be a move into an Assisted Living or SNF on the horizon. For possible rehab in the future, you’d prefer that it be done on the same campus, so you don’t want to be concerned if the out-sourced therapy group du jour of your facility is in or out of a MA network. In short, traditional Medicare offers the greatest ability to “go with the flow,” which may be worth the extra cost.
Some people may not realize that admission into a SNF can permit a switch-over from a MA to original/traditional Medicare at a time outside the annual Open Enrollment period. At least that was the case in 2011 when my mother moved into the nursing home facility within her CCRC. She made the early in the year, and we could make the change to original Medicare right away, versus having to wait for the fall Open Enrollment. That was helpful.

Posted by: Jennifer Young | Jul 10, 2017 9:55:59 AM

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