In-home care providers with a mission to serve particularly vulnerable populations often target “dual eligibles,” or individuals signed up for both Medicare and Medicaid benefits.
The focus on dual-eligible populations is partly driven by mission and values, but it’s also supported by reimbursement. While in-home care providers sometimes struggle operating purely in the Medicaid long-term care space due to stagnating reimbursement rates, the dual-eligible landscape offers more financial sustainability.
Take, for example, Huntington Beach, California-based Landmark Health, a company that coordinates and delivers in-home medical care to mostly older adults with complex conditions.
Landmark currently operates across more than a dozen states, with dual-eligible beneficiaries being an important part of its overall patient mix of roughly 114,000.
CEO Nick Loporcaro discussed the strategic value of duals Thursday during the Better Medicare Alliance (BMA) Medicare Advantage Virtual Summit.
“If you look at the Medicaid population, due to what I call a flawed reimbursement system …, we have a tough time justifying the costs around that,” Loporcaro said. “Now, if I’ve got the MA advantage, I get to address and take care of a population that I would have struggled to justify bringing in. So, we actually like duals and perform well with duals.”
Specifically, Loporcaro was referring to dual-eligible beneficiaries enrolled under Medicare Advantage — a rapidly growing population.
Of the roughly 9.6 million full or partial dual-eligible individuals in 2013, about 2.4 million — or about 25% — enrolled in Medicare Advantage, according to a new report from actuarial consulting firm Milliman and BMA. By 2019, the number of total dual eligibles increased to 12.3 million individuals, with 5.4 million — or about 44% — enrolling in Medicare Advantage.
That’s a jump of about 125% over six years. From 2013 to 2019, the number of dual-eligible beneficiaries enrolled in traditional Medicare dropped by 5%.
“[With] dramatic growth in enrollment among dual-eligible beneficiaries, we know that supporting health coverage for our most vulnerable seniors means supporting these individuals’ choice of Medicare Advantage,” BMA President and CEO Allyson Y. Schwartz said in a press release touting the report.
Dual-eligible individuals typically have more social determinants of health needs, possibly one reason for the increase under Medicare Advantage, especially as more plans offer home-focused supplemental benefits.
Medicare Advantage growth
The sharp rise in dual eligibles in Medicare Advantage is an important consideration for in-home care providers attempting to move away from fee-for-service Medicare.
Of course, it’s not just the duals population that is increasing, as overall Medicare Advantage continues to climb as well, the BMA-Milliman report shows.
In 2019, there were about 64 million Medicare beneficiaries in total, with roughly 24 million — or more than 37% — enrolling in a Medicare Advantage plan. The Congressional Budget Office (CBO) projects that Medicare Advantage enrollment will grow to nearly 50% by 2029.
Former CMS Administrator Tom Scully — who helped create the Medicare+Choice model, a precursor to today’s Medicare Advantage program — touched on that growth during BMA’s virtual summit.
“I’m very bullish on the future of Medicare Advantage. I think it’s a great program,” Scully said. “The growth is going to continue, and that’s because seniors like it, seniors support it and, economically, it makes a whole lot of sense.”
While the Medicare Advantage population grew by 60% from 2013 to 2019, the fee-for-service Medicare population only grew by 5%.
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