Managed Care Models Improve Outcomes for Beneficiaries Who Are Partially Dual Eligible
Managed care has positive effects on health care utilization for people who are eligible for Medicaid assistance in paying for certain Medicare costs (known as “partial dual eligibles”). These effects include higher rates of primary care visits and lower rates of inpatient hospitalizations, readmissions, and skilled nursing facility stays, as compared to Traditional Medicare (TM).
Beneficiaries who are partially dual eligible often experience complex social and medical needs. They could benefit from managed care or a tailored health plan, such as Dual Eligible Special Needs Plans (D-SNPs).
This analysis compared outcomes for partial dual eligible individuals enrolled in managed care plans, specifically Medicare Advantage plans and D-SNPs, and those enrolled in TM. The Elevance Health Public Policy Institute engaged Health Management Associates and Berkeley Research Group to examine Medicare data for beneficiaries who are partially dual eligible. They conducted analyses of Medicare fee-for-service claims data and MA encounter data.
Related Public Policy Research
Medicare Advantage (MA) plans provide enrollees a valuable alternative to Medicare fee-for-service (FFS) by offering out-of-pocket cost protections, additional benefits, and innovative strategies for care management and coordination.
Medicare Advantage (MA) plans offer additional benefits not covered by traditional Medicare known as supplemental benefits. This paper examines the use of supplemental benefits overall and by demographic characteristics of MA members, demonstrating that supplemental benefits can address health-related social needs.
Partial duals have medical, social, and functional needs that are similar to those of full duals and are likely to experience changes in their Medicaid eligibility status during the year.