Dying MA customers are switching to traditional Medicare

Modern Healthcare / Michael Brady
Medicare Advantage beneficiaries can't access the care they need as they get sicker, a new report from federal watchdogs suggests.
People enrolled in Medicare Advantage plans are switching to Medicare fee-for-service at an alarming rate during their last year of life, according to a Government Accountability Office (GAO) report published Wednesday. Medicare Advantage customers in their last year of life were more than twice as likely to drop their policies and enroll in Medicare fee-for-service than other Medicare Advantage enrollees.
"Among other reasons, beneficiaries in the last of year life may disenroll because of potential limitations accessing specialized care under MA," the GAO concluded.
In 2017, 5% of Advantage beneficiaries in their last year of life converted to traditional Medicare, compared to 2% of all other enrollees, the oversight agency reported.
Medicare Advantage has grown popular over decades as beneficiaries opt for insurance policies that come with extra benefits not available in traditional Medicare. But given their nature as private insurance products with limitations such as provider networks and varying benefit designs, Medicare Advantage has always drawn skeptical appraisals from those concerned about access to care.
"Beneficiaries in their last year of life are generally high-cost and disproportionately require specialized care, with a few studies estimating that they may account for as much as a fifth to a quarter of all [fee-for-service] spending," the GAO found. The federal government would have saved $912 million during 2016 and 2017 had fewer Medicare Advantage enrollees opted into traditional Medicare during their last year of life, the GAO estimates.
The watchdog recommends CMS review disenrollment by Medicare Advantage customers in their last year of life as part of the agency's broader analysis of Medicare Advantage beneficiaries in poor health who switch to fee-for-service Medicare. The agency began that evaluation after the GAO reported in 2017 that sicker beneficiaries are more likely to drop out of Medicare Advantage.
"Given their high costs and specialized care needs, a specific focus on disenrollments by beneficiaries in their last year of life could help CMS better identify and address potential concerns regarding their care under MA, and ensure efficient Medicare program spending," the GAO report say.
HHS agreed with GAO's recommendation.