Federal government may be paying twice for care of veterans enrolled in Medicare Advantage plans

From 2011 to 2020, the Veterans Well being Administration spent $78 billion to take care of U.S. army veterans enrolled in Medicare Benefit plans, elevating questions on federal overpayments to these non-public plans.

That is in response to an evaluation by researchers from Brown College and the Windfall Veterans Affairs Medical Heart. Printed in JAMA, the examine notes that as a result of Medicare Benefit plans obtain fastened per-patient funds for well being care companies with out having funds diminished when veterans obtain care by means of the Veterans Well being Administration, the twin enrollment of some veterans could end in extra federal spending than is important.

“When the federal authorities pays for care by means of the Veterans Well being Administration and pays Medicare Benefit plans the total quantity, it could imply the federal government is paying twice for the care of the identical beneficiaries,” stated examine writer David Meyers, an assistant professor of well being companies, coverage and apply at Brown College’s College of Public Well being. “These potential overpayments might correspond to substantial extra spending by the federal authorities.”

The Medicare Benefit program is the privately run arm of the Medicare program, wherein non-public insurance policy are paid by the federal authorities to ship Medicare advantages, Meyers stated. The Medicare Benefit program is rising quickly, and the variety of army veterans who used Veterans Well being Administration companies elevated by 63% from 634,470 in 2011 to 1,033,643 in 2020.

The researchers used Veterans Well being Administration (VHA) enrollment knowledge to establish all veterans who have been dually coated by Medicare Benefit and the VHA and used VHA companies from 2011 to 2020. They discovered that the VHA paid greater than $78 billion for well being companies. Additionally they discovered that whereas the VHA paid for the veterans’ well being care, the federal Medicare program concurrently made full funds for every dually enrolled veteran to their Medicare Benefit plan.

“The Medicare Benefit plan will get paid even when it is not essentially delivering well being care to the beneficiaries,” Meyers stated.

Meyers recommended two methods to handle the overpayment downside: Scale back the funds the Medicare Benefit plans obtain for beneficiaries who’ve VHA protection, or enable the VHA to hunt reimbursement from the Medicare plan. Reimbursement makes essentially the most sense, he stated, as a result of veterans will nonetheless be coated no matter the place they obtain their well being care.

Beneath Part 1862 of the Social Safety Act, care supplied by VA and different governmental entities (with sure exceptions) isn’t coated beneath Medicare, and VA doesn’t search reimbursement from Medicare or Medicare Benefit plans. VA does invoice non-public medical insurance for sure non-service-connected medical care supplied to Veterans, funds that immediately help the care and companies supplied to Veterans.

“There must be a possibility for the Veterans Well being Administration to hunt reimbursement from Medicare so as to have the ability to afford to ship the care that veterans want and deserve,” Meyers stated.

The authors hope to conduct extra analysis to disclose the exact quantity of duplicate spending.

This evaluation is a component of a bigger examine led by Dr. Amal Trivedi, a Brown College professor of well being companies, coverage and apply and of medication who can be a doctor on the Windfall V.A. Medical Heart.

“We’re specializing in the expansion of enrollment in Medicare Benefit amongst veterans and what meaning for Veterans Administration’s well being care,” Trivedi stated. “This examine highlights the necessity to additional perceive the implications of veterans enrollment in Medicare Benefit on doubtlessly duplicative federal spending.”