14. Enroll All Beneficiaries Covered by Both Medicaid and Medicare in Managed Care
Approximately 9 million low-income older and disabled people are covered by both Medicaid (a federal-state program that provides assistance to low-income people) and Medicare. These people are referred to as "dual eligibles." Because Medicare and Medicaid have different coverage rules and provider access, and dual eligibles are generally a less healthy population, there are higher costs and greater challenges in providing health care for this population. Proposals include requiring all low-income older people to enroll in a managed care plan, which means the care they receive would need to come from doctors and hospitals in the provider network for that managed care plan.
PRO: All low-income seniors should be required to enroll in a managed care plan to reduce confusion for beneficiaries about what is covered, improve the care they receive through better coordination among their many doctors and providers, and lower costs for the Medicare and Medicaid programs. Currently, people with both Medicare and Medicaid receive their health care through two programs, with different rules and different networks of doctors and providers. Better management of care could reduce wasteful or unnecessary use of health services and could reduce medical complications that can lead to more expensive care and treatment. By some estimates, these savings could amount to well over $100 billion for Medicare and Medicaid. With these savings, some managed care plans may even be able to offer additional patient services and support, such as free dental services or access to nurse help telephone lines. (Avalere Health)
CON: It is wrong to force low-income Medicare beneficiaries into managed care plans while those with higher incomes are allowed to keep their current doctors and other health care providers in the traditional Medicare program. In addition, it is unclear whether managed care will even reduce costs. In fact, some studies even show that federal costs go up when Medicare beneficiaries are enrolled in managed care. There are other ways to improve care and reduce costs for people with both Medicaid and Medicare that do not require enrollment into a managed care plan. For example, some states allow beneficiaries to remain in traditional Medicare but pay a primary care physician an extra fee to coordinate and manage the patient’s care. These programs have demonstrated some success in improving care and reducing costs for individuals with Medicare and Medicaid. Such options — which do not require giving up one’s doctor — are better alternatives to mandatory enrollment into managed care. (Avalere Health)