A new study by David Meyers, Brown University School of Public Health, et al., of people enrolled in Medicare Advantage plans, published in JAMA Internal Medicine, shows that people with high health care needs disenroll from these commercial Medicare health plans into traditional Medicare at higher rates than people in better health. Their findings suggest that commercial health plans, overall, are not in business to meet the needs of people with complex conditions.

Medicare Advantage plans have financial incentives to attract healthy members and steer less healthy members out of their plans. The federal government pays these plans a fixed rate per member. The less care each member receives, the more money the health plan gets to keep.

The study’s authors find that rates of disenrollment from Medicare Advantage plans increase after people experience a serious health condition. The Government Accountability Office also has studied this issue and found that a high proportion of people disenroll from Medicare Advantage plans when they have serious health care needs.

We have little clue how poorly the people with complex conditions who remain in their Medicare Advantage plans fare. Some evidence is concerning. In May 2018, Just Care reported on another study showing that enrollees in Medicare Advantage plans are more likely to end up in poorer quality skilled nursing facilities than people in traditional Medicare. More recently, a judge in Northern California found that UnitedHealth illegally denied necessary care to tens of thousands of enrollees with mental health needs.

Poor treatment by commercial health plans of people with costly conditions is one reason why proponents of Medicare for All support improving and expanding Medicare to everyone. Medicare for All would fill gaps in traditional Medicare coverage, eliminating premiums, deductibles and coinsurance and adding vision, hearing, dental and long-term care. Medicare for All would also end commercial health insurance, including Medicare Advantage plans, which drive up costs and differ dramatically from traditional Medicare.

The study’s authors looked at data of 13.9 million people enrolled in Medicare Advantage plans over a two-year period. They found a disenrollment rate of 4.6 percent for people with high needs as compared to a disenrollment rate of 3.3 percent for people without high needs. They infer from the data that Medicare Advantage plans are less likely to meet the preferences of people with complex conditions than people with fewer health care needs.

The authors’ findings confirm what we already know. People with complex conditions are often hard-pressed to see the doctors they want to see and get the care they need when enrolled in a commercial Medicare Advantage plan.

Of course, not all Medicare Advantage plans are alike. The study’s authors suggest that the ones with low star ratings are likely less well-equipped to meet the needs of people with costly conditions. But, the Medicare Advantage plans with five-star ratings could be ones that are engaged in wrongful delays and denials of care; the five-star ratings do not say enough about a plan’s performance to rely upon.

The authors do not disclose the names of the Medicare Advantage plans with the disproportional disenrollment among enrollees needing costly care. Generally, Medicare Advantage plans only allow researchers to use their data on the condition that the researchers not call out particular health plans; in some cases, the researchers do not know which data belongs to which health plans. Keeping this information confidential is a particular disservice to the public.

The authors categorized people as having a high health need if they have two or more “complex chronic conditions such as heart failure, chronic obstructive pulmonary disorder, and depression” or “six or more chronic conditions.” They also looked at dual-eligibles–people with Medicare and Medicaid.

Dual-eligibles with costly health needs disenrolled from Medicare Advantage plans to traditional Medicare at higher rates than others. But, the authors did not explore whether this is because others may not be able to buy the supplemental coverage they need to fill coverage gaps if they switch to traditional Medicare. The ability to buy supplemental coverage is not guaranteed in many states, except when people initially enroll in Medicare at 65.

This analysis was written by Tarbell board member Diane Archer and originally published in the health news and advisory platform Just Care on 3/6/2019. Tarbell is republishing this piece with permission.