Every day, approximately 12 million Americans depend on both Medicare and Medicaid to help them get vital access to care they need and deserve. These “dual eligibles” have more chronic conditions, greater levels of disabilities, and are more likely to need nursing home care.
Dual eligibles typically have annual incomes below the Federal Poverty level ($14,580 for a single person in 2023). A majority of them live in historically underinvested or underrepresented communities and are more adversely affected by social drivers of health. And more than 5 million dual eligibles are enrolled in special needs plans (SNPs), Medicare Advantage (MA) plans that provide highly coordinated care and services tailored to a person’s specific needs.
That’s why the billions of dollars in cuts to MA in the Centers for Medicare and Medicaid Services’ (CMS) 2024 Advance Rate Notice pose a serious threat to the health and well-being of millions of America’s most vulnerable individuals. AHIP commissioned a study by the Wakely Consulting Group which reviewed data from a broad range of MA plans. Wakely found that, on average, the proposed risk model in the Advance Notice would cut payments for dual eligibles by 6.4%. At a time when living expenses are squeezing budgets across America, cuts to programs serving our most vulnerable seniors and people with disabilities is just bad policy.
The cuts CMS is proposing in many cases will reduce payments for treatment and care for serious health concerns such as major depressive disorder, diabetes with chronic conditions, and cardiovascular disease - conditions that disproportionately affect dual eligibles.
- According to the American Diabetes Association, Black Americans are 64% more likely to have diabetes than Whites, while
Hispanic Americans are 60% more likely than non-Hispanic Whites to have diabetes.
- A 2022 report found that major depression goes undiagnosed and untreated at disproportionally greater rates in majority Black
and Hispanic communities.
Cuts to MA put at risk the benefits and services designed to help dual eligibles achieve better health and outcomes.
- Some MA cuts will make it more difficult for Medicare plans to care for people with certain conditions, such as mental health
disorders, complications following transplants, and certain metabolic disorders that affect dual eligibles disproportionately.
Cuts to MA jeopardize other important social services.
- To help overcome social barriers to better health, many MA plans for dual eligibles provide their members with access to services
like nutrition counseling, transportation to medical appointments, in-home support, and other benefits. Cuts in the 2024 Advance
Rate Notice also mean that these important benefits would be jeopardized.
Cuts to Medicare Advantage will impact those who can least afford it. Seniors are clear: Don’t cut Medicare Advantage.