On Wednesday of last week U.S. Senators Bill Cassidy, M.D. (R-La.) and Debbie Stabenow (D-Mich.) released discussion draft legislation following a troubling U.S. Government Accountability Office (GAO) report conducted at the request of the Senators. The report shows Medicare Advantage (MA) beneficiaries in the last year of life disenrolled to join Medicare fee for service (FFS), or “original Medicare,” at more than twice the rate of all other MA beneficiaries.
The report stated, “Stakeholders told GAO that, among other reasons, beneficiaries in the last of year life may disenroll because of potential limitations accessing specialized care under MA.” It also showed that MA disenrollment in the last year of life increased overall costs to the Medicare program, estimating that FFS payments for such beneficiaries were $490 million higher than if they would have stayed in MA in 2017.
“Medicare Advantage gives seniors better care at a lower cost,” said Dr. Cassidy. “To improve this program, we need to make sure it best serves beneficiaries in their last year of life and does not shift costs to other parts of Medicare and taxpayers.”
“This report is alarming and raises serious questions. I’m very concerned that insurance companies may be denying seniors enrolled in Medicare Advantage plans the care they need, right when they need it the most. In addition to disrupting care, this leaves seniors and the government on the hook for higher costs. I look forward to further investigating this issue and working with Senator Cassidy on legislation to make sure seniors get the high-quality health care they need,” said Senator Stabenow.
The discussion draft marks the beginning of a conversation to uncover the reason patients are facing these limitations and form solutions. Should this concerning trend continue, the discussion draft suggests requiring MA plans to retroactively pay for the first 90 days of FFS claims following a patient disenrolling from MA into FFS when in their last year of life.