Nonwhite, Disabled Enrollees Are More Likely to Switch from MA to FFS, Study Shows

by Lauren Flynn Kelly

Previous research has suggested that disabled adults who rely on services such as home health and nursing home care are more likely to switch from Medicare Advantage to traditional, fee-for-service (FFS) Medicare. Now, a new study appearing in Health Affairs confirms researchers' assumptions that such switching is more prevalent among MA beneficiaries who are nonwhite and/or from vulnerable sociodemographic groups.

Researchers from the Icahn School of Medicine at Mount Sinai in New York City and the University of California San Francisco examined five years of data from the National Health and Aging Trends Study to assess switching between MA and traditional Medicare 12 months before and after the onset of a disability.

They found that 10.6% of people who were initially in MA switched to traditional Medicare and that the incidence of switches per 1,000 person-years climbed from 53.5 before disability to 65.6 after disability.

The authors also observed that nonwhite respondents had higher rates of switching both before and after disability — particularly those who started in MA plans. Before disability onset, those who were in MA plans had 94.3 vs. 63.6 switches per 1,000 person-years for those in traditional Medicare. The rates after disability were 81.9 vs. 71.0 switches per 1,000 person-years.

"One potential reason why a person with special needs or other chronic conditions may switch to fee-for-service Medicare is the network," observes Matt Kazan, a principal with Avalere Health. If patients are diagnosed with a new disease and then discover that the providers they need aren't in network, they tend to move to open-network FFS.

But switching out of MA plans "may have unanticipated financial impacts on patients, given that in most states Medigap plans to supplement traditional Medicare coverage can refuse coverage to those with preexisting conditions if a person is not new to Medicare," pointed out the study's authors.

Kazan says it would be interesting to see study results using more current data given that from 2011 to 2016, certain Affordable Care Act payment and risk adjustment changes were being phased in, and MA beneficiaries now have access to more home-based supports thanks to CHRONIC Care Act provisions contained in the Bipartisan Budget Act of 2018.

From RADAR on Medicare Advantage