Rapid Enrollment Growth In ‘Look-Alike’ Dual-Eligible Special Needs Plans: A Threat To Integrated Care

The Rise and Risks of Medicare Advantage “Affinity Plans”

“…5 Between 2013 and 2020, these look-alike plans experienced a rapid, 11-fold growth. 5 Yet the Medicare Payment Advisory Commission (MedPAC)…”

“…Moreover, policymakers need to act swiftly when signals of poor quality emerge. Despite years of attention from researchers and MedPAC, D-SNP look-alike plans had enrolled hundreds of thousands of beneficiaries during more than a decade before CMS implemented a rule that went into effect in 2023 to phase them out …”

“…4 Yet recent evidence documents the emergence of D-SNP "look-alike plans," MA plans that were marketed to beneficiaries as offering better coordination between Medicare and Medicaid benefits, but in fact circumvented federal D-SNPs' regulatory requirements for integrating services. 5 Between 2013 and 2020, these look-alike plans experienced a rapid, 11-fold growth. 5 Yet the Medicare Payment Advisory Commission (MedPAC)…”

“…Despite years of attention from researchers and MedPAC, D-SNP look-alike plans had enrolled hundreds of thousands of beneficiaries during more than a decade before CMS implemented a rule that went into effect in 2023 to phase them out. 5 As MA continues its growth and solidifies as the dominant form of coverage for Medicare beneficiaries, market forces are leading to the proliferation of MA plans targeting specific groups of individuals according to cultural, sexual orientation, race, ethnicity, and veteran status. Although these MA affinity plans may offer potential benefits to beneficiaries, policymakers can ensure the plans improve care rather than compromise health gains for vulnerable beneficiaries.…”

“…Because dual-eligible beneficiaries often have medically complex needs and would benefit from greater coordination of their care and services, Congress and the Centers for Medicare & Medicaid Services (CMS) created laws that promoted growth of plans that financially integrate services between Medicare and Medicaid, including the Dual-Eligible Special Needs Plans (D-SNPs) . Yet recent evidence documents the emergence of D-SNP “look-alike plans,” MA plans that were marketed to beneficiaries as offering better coordination between Medicare and Medicaid benefits, but in fact circumvented federal D-SNPs’ regulatory requirements for integrating services . Between 2013 and 2020, these look-alike plans experienced a rapid, 11-fold growth .…”