Differences In Care Between Special Needs Plans And Other Medicare Coverage For Dual Eligibles

Abstract

Policy makers are pursuing strategies to integrate Medicare and Medicaid coverage for people enrolled in both programs, who are known as dual eligibles. Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans that exclusively serve this population, with several features intended to enhance care and facilitate integration with Medicaid. This study compared access to, use of, and satisfaction with care among dual eligibles enrolled in D-SNPs versus those enrolled in two other forms of Medicare coverage: other Medicare Advantage (MA) plans not exclusively serving dual eligibles and traditional Medicare. Compared with those in traditional Medicare, dual eligibles generally reported greater access to care, preventive service use, and satisfaction with care in D-SNPs. However, we found fewer differences in these outcomes among dual eligibles in D-SNPs versus other MA plans. Compared with non-Hispanic White dual eligibles, dual eligibles of color (for example, those identifying as Black or Hispanic) were less likely to report receiving better care in D-SNPs versus other Medicare coverage. These findings suggest that D-SNPs altogether have not provided consistently superior or more equitable care, and they highlight areas where federal and state policy could strengthen incentives for D-SNPs to improve care.

Exhibit 2:

Access to, use of, and satisfaction with care among dual-eligibles enrolled in Dual Eligible Special Needs Plans, other Medicare Advantage plans, and traditional Medicare Notes: Figure displays adjusted rates of study outcomes among dual eligibles in Dual Eligible Special Needs Plans (D-SNPs), other Medicare Advantage plans not exclusively serving dual eligibles, and traditional Medicare. Shaded circles show adjusted estimates. Error bars show 95% confidence intervals, constructed using robust standard errors clustered at the respondent level to account intra-person correlation over time. Estimates adjusted for covariates in Exhibit 1, annual supply of physicians per 1,000 county residents, annual supply of dentists per 1,000 county residents, state fixed effects, and year fixed effects, and weighted by a composite of propensity score weights and survey weights. Adjusted estimates calculated using the method of average marginal effects (see Appendix for details). Exhibit 3 reports corresponding regression estimates for the adjusted differences in study outcomes between dual eligibles enrolled in D-SNPs vs. other Medicare Advantage plans or traditional Medicare. ^a Question not asked in the 2015 MCBS. ^b Question was asked only of new survey respondents in the 2015 and 2016 MCBS. Source: Authors’ analyses of the MCBS from 2015–2019.