A new study reveals that the federal government may be paying twice for the care of veterans enrolled in Medicare Advantage plans. The research, conducted by experts from Brown University and the Providence Veterans Affairs Medical Center, sheds light on a potential issue of overpayment that could result in substantial additional spending. This article explores the implications of this finding and discusses possible solutions to address the problem. Medicare and Veterans Affairs are both critical components of the healthcare system in the United States.
Overpayment due to Dual Enrollment
Between 2011 and 2020, the VHA spent more than $78 billion on health care for U.S. military veterans enrolled in Medicare Advantage plans, according to the study. That leads to questions about if the federal government is overpaying these private plans. The problem is that VHA care for veteran enrollees does not reduce the fixed per-patient payments Medicare Advantage plans receive from traditional Medicare; it simply diverts services and associated income.
The new approach utilized in this study could reveal that “When the federal government pays for care through the Veterans Health Administration and pays Medicare Advantage plans the full amount, it may mean the government is paying twice for the care of the same beneficiaries,” according to researchers. This potential double-dipping on payments could create major new spending commitments for the country, so it deserves a thorough discussion of its true costs.
Explosive Growth in MA Enrollment by Vets
Medicare Advantage, the privately operated portion of Medicare care has seen a huge expansion in recent years. Strikingly, the Veterans Health Administration saw its VHA services-buser population grow 63% from 634,470 in 2011 to nearly a million at over a million by 2020. Enrollment spikes and risk of double payments demonstrate why tackling this problem is crucial.
For the broad population, the researchers used VHA enrollment data to determine all veterans who were dually covered by Medicare Advantage and the VHA, then tracked eligible health services that were paid for directly by the VHA from 2011 through 2020. In other words, their findings imply that the VHA paid for the veterans’ healthcare and at the same time, so did the federal Medicare program, which continued to make full payments to those particular Medicare Advantage plans.
Solutions to reduce overpayments
Researchers suggest two ways to fix overpaying The other option is to lower the payments made to Medicare Advantage plans for enrolling veterans who have VHA coverage. The second and perhaps more feasible solution is to permit the VHA to have expanded Medicare Advantage plan capacity.
The study author, Meyers, said that payment should be the most logical strategy which would allow veterans their ability to get the treatment they need via disallowed services. The SSA does not include VA care for reimbursement and the VA Documents do not bill Medicare or Medicare Advantage plans. “Veterans are forced to go elsewhere because the VA doesn’t have enough of the required services, and they should be allowed to get those services within the VA — and in order for that to happen, I think you’ve got to give at least some opportunity for recovery from Medicare,” Meyers said.
Additional research is needed to look into the details of how much duplicate spending takes place, they added — information that could help policymakers and administrators decide how best to address this problem.
