Medicaid and Medicare are the two largest health insurance programs serving Americans, but they cover care for different populations: Medicaid is an assistance program run by states for people with low incomes, and Medicare is a federal medical insurance program for senior citizens or younger people with disabilities.
So, what happens when someone is eligible for both, as is the case for 12 million people in the U.S.?
“People who are ‘dual eligible’ are, by definition, medically and socially vulnerable – and they’re often stuck navigating two different insurers,” said Dr. Eric Roberts, assistant professor in the University of Pittsburgh School of Public Health’s Department of Health Policy and Management. “It can – understandably – be really difficult. But there is growing interest among policymakers in enhancing coverage and improving care coordination for dual eligibles to make their care easier to navigate.”
Roberts recently partnered with Dr. Jennifer Mellor, professor of economics at the College of William and Mary, to explore the differences in care resulting from the various ways that dual eligibles access both Medicare and Medicaid. Their results are reported in the September issue of Health Affairs and explained by Roberts in a podcast that posted today.
The team compared access to, use of and satisfaction with care among dual eligibles enrolled in Dual Eligible Special Needs Plans (D-SNPs) – which are Medicare Advantage plans that exclusively serve dual eligibles – versus those enrolled in other Medicare Advantage plans or traditional Medicare.
D-SNPs have several features that are intended to improve access and care coordination for enrollees. These include requirements for D-SNPs to have care models tailored to dual eligibles and work with state Medicaid programs to coordinate care. “In principle, the D-SNP is supposed to simplify and coordinate coverage for dual eligibles, though how well that works in practice can vary,” said Roberts.
After analyzing national survey data collected between 2015 and 2019 and broken down by plan type and race or ethnicity, Roberts and Mellor found that D-SNPs generally performed better than traditional Medicare across most measures of access, preventive services and satisfaction. But, when the authors compared dual eligibles in D-SNPs to dual eligibles in regular Medicare Advantage plans, which did not exclusively serve this population, D-SNPs generally did not perform as well.
And, in the few areas where D-SNPs did perform better than regular Medicare Advantage, it was only among people who identified as non-Hispanic white. These findings suggest that D-SNPs did not, as a whole, provide better or more equitable care for dual eligibles than regular Medicare Advantage plans.
“D-SNPs have yet to deliver on the potential to provide better care for vulnerable enrollees,” Roberts said. “D-SNPs clearly aren’t hitting it out of the ballpark when it comes to enrollees being satisfied that they have improved access or care coordination.”
One area where Roberts said policy changes could help is for the Centers for Medicare and Medicaid Services to require plans to report their performance broken out by race and ethnicity.
“This would provide greater visibility about how well D-SNPs are serving vulnerable enrollees and guide how we might improve these plans in the future,” said Roberts. “This is critical as the dual eligible population continues to grow.”