Study Finds Differences in Medicare vs. Medicare Advantage in Final Months of Life

According to research published in JAMA Health Forum and reported by HospiceNews.com, Medicare Advantage (MA) beneficiaries are less likely to receive intensive treatments or burdensome transfers during the last six months of life compared to those in traditional Medicare. This research found that MA enrollees were also more likely to receive hospice care and less likely to receive facility-based care after a hospital discharge. A key factor is MA’s focus on controlling costs, whereas fee-for-service Medicare incentivizes more aggressive treatment, researchers indicated. But at the same time they pointed to gaps in which MA patients don’t always receive sufficient post-acute care, such as skilled nursing care. They tend to receive more home care after discharge, but the financial incentives with MA may still leave some patients without such home care. The study authors also noted that home-based care can burden family caregivers, including imposing the stress of navigating both MA coverage and Medicare’s hospice benefit.

“Financial incentives in Medicare Advantage were designed to reduce overutilization,” the authors wrote. “For patients near the end of life, MA incentives may reduce potentially burdensome care and encourage hospice but could also restrict access to costly but necessary services.” For the study, researchers examined Medicare claims data for more than 1 million patients who died between 2016 and 2018.

This particular research conflicts somewhat with earlier findings published in JAMA Health Forum that saw MA patients getting slimmer home health care services than their counterparts in traditional Medicare. The differences can be important because more than half of Medicare beneficiaries are in MA plans.