Federal government may be paying twice for care of veterans enrolled in Medicare Advantage plans
Brown University —
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That’s according to an analysis by
researchers from Brown University and the Providence Veterans Affairs Medical
Center. Published in JAMA, the study notes that because Medicare Advantage
plans receive fixed per-patient payments for health care services without
having payments reduced when veterans receive care through the Veterans Health
Administration, the dual enrollment of some veterans may result in more federal
spending than is necessary.
“When the federal government pays for care through the
Veterans Health Administration and pays Medicare Advantage plans the full
amount, it may mean the government is paying twice for the care of the same
beneficiaries,” said study author David Meyers, an assistant professor of
health services, policy and practice at Brown University’s School of Public
Health. “These potential overpayments could correspond to substantial
additional spending by the federal government.”
The Medicare Advantage program is the privately run
arm of the Medicare program, in which private insurance plans are paid by the
federal government to deliver Medicare benefits, Meyers said. The Medicare
Advantage program is growing rapidly, and the number of military veterans who
used Veterans Health Administration services increased by 63% from 634,470 in
2011 to 1,033,643 in 2020.
The researchers used Veterans Health Administration (VHA) enrollment data to identify all veterans who were dually covered by Medicare Advantage and the VHA and used VHA services from 2011 to 2020. They found that the VHA paid more than $78 billion for health services. They also found that while the VHA paid for the veterans’ health care, the federal Medicare program simultaneously made full payments for each dually enrolled veteran to their Medicare Advantage plan.
“The Medicare Advantage plan gets paid even when it’s not
necessarily delivering health care to the beneficiaries,” Meyers said.
Meyers suggested two ways to address the overpayment
problem: Reduce the payments the Medicare Advantage plans receive for
beneficiaries who have VHA coverage, or allow the VHA to seek reimbursement
from the Medicare plan. Reimbursement makes the most sense, he said, because
veterans will still be covered regardless of where they receive their health
care.
Under Section 1862 of the Social Security Act, care provided
by V.A. and other governmental entities (with certain exceptions) is not
covered under Medicare, and V.A. does not seek reimbursement from Medicare
or Medicare Advantage plans. V.A. does bill private health insurance for
certain non-service-connected medical care provided to veterans, funds that
directly support the care and services provided to veterans.
“There should be an opportunity for the Veterans Health
Administration to seek reimbursement from Medicare in order to be able to
afford to deliver the care that veterans need and deserve,” Meyers said.
The authors hope to conduct additional research to reveal
the precise amount of duplicate spending.
This analysis is part of a larger study led by Dr. Amal
Trivedi, a Brown University professor of health services, policy and practice
and of medicine who is also a physician at the Providence V.A. Medical Center.
“We’re focusing on the growth of enrollment in Medicare
Advantage among veterans and what that means for Veterans Administration’s
health care,” Trivedi said. “This study highlights the need to further
understand the implications of veterans enrollment in Medicare Advantage on
potentially duplicative federal spending.”
Funding for this research was provided by the Providence
Veterans Affairs Medical Center’s Center of Innovation.
