STAT+: Medicare Advantage plans for dual-eligible enrollees set to get Senate scrutiny
About a third of Medicare and Medicaid spending goes toward the 15% of beneficiaries who are eligible for both programs, but insurers aren't coordinating care to achieve good outcomes, some…
The Senate has set its eyes on regulating insurance plans for some of the most vulnerable patients in the U.S. — the 12.5 million people eligible for both Medicare and Medicaid.
“They’re a complex group of people with a lot of chronic conditions — mental illness, frailty, disability,” said Jose Figueroa, an internal medicine physician and health policy expert at Brigham and Women’s Hospital. Over a third of these dual-eligible beneficiaries have less than a high school education, and about 90% make less than $20,000 per year.
Just around 15% of beneficiaries are eligible for both Medicare and Medicaid, but they account for a third of these programs’ spending — around $440 billion — and still don’t receive better health care, Sen. Bill Cassidy (R-La.) pointed out in a JAMA viewpoint published earlier this month. “The root cause of worse outcomes despite spending more money is a lack of coordination of care,” Cassidy wrote.
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