Medicare Advantage: beneficiary disenrollments to fee-for-service in last year of life increase Medicare spending : report to Congressional requesters
- Collection:
- Health Policy and Services Research
- Contributor(s):
- United States. Government Accountability Office. issuing body. United States. Congress. issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, June 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Government Regulation Medicare Part C -- economics Terminal Care -- economics United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Why GAO did this study. In contrast to Medicare FFS, which pays providers for claims for services, CMS pays MA plans a fixed monthly amount per beneficiary to provide health care coverage. For beneficiaries with higher expected health care costs, MA payments are increased. In 2019, CMS paid MA plans about $274 billion to cover about 22 million beneficiaries. Prior GAO and other studies have shown that beneficiaries in poorer health are more likely to disenroll from MA to join FFS, which may indicate that they encountered issues with their care under MA. Beneficiaries in the last year of life are generally in poorer health and often require high-cost care. GAO was asked to review disenrollment by MA beneficiaries in the last year of life. In this report, GAO examined (1) disenrollments from MA to join FFS by beneficiaries in the last year of life, and CMS’s associated monitoring; and (2) the costs of such disenrollments to Medicare. GAO analyzed CMS disenrollment and mortality data for 2015 through 2018— the most current data at the time of the analysis—to examine the extent of MA beneficiary disenrollment in the last year of life. To estimate the costs of disenrollment, GAO used CMS data to estimate payments for disenrolled beneficiaries had they remained in MA, and compared those estimates against those beneficiaries’ actual FFS costs. What GAO recommends. GAO recommends that CMS review disenrollments by MA beneficiaries in the last year of life as part of its monitoring. The Department of Health and Human Services concurred with GAO’s recommendation.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (iii, 34 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918317488006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918317488006676