'Look-alike' dual eligible plans are misleading Medicare Advantage enrollees, researchers say

"Look-alike" dual eligible Medicare Advantage plans — which primarily enroll people eligible for Medicare and Medicaid but are not regulated as D-SNP plans — grew significantly from 2013 to 2020, a study published in the July issue of Health Affairs found. 

The study found enrollment in MA plans that had more than 80 percent dual-eligible beneficiaries, but were not regulated as D-SNP plans, grew 11 times from 2013 to 2020. The number of plans with high numbers of dual eligible beneficiaries rose from six in 2013 to 58 in 2020. 

Look-alike plans are often marketed toward dual-eligible beneficiaries, which often have more complex health needs, according to the study. Unlike D-SNP plans, these plans are not required to contract with state Medicaid programs to coordinate care. 

As of January, CMS no longer contracts with Medicare Advantage plans with more than 80 percent dual-eligible enrollees. The study's authors wrote this regulation may not eliminate all look-alike plans, because many plans enroll more than 50 percent but below 80 percent dual-eligible enrollees. The number of plans with more than 50 percent of enrollees eligible for Medicare and Medicaid rose from 14 in 2013 to 120 in 2020. 

Look-alike plans were more likely to enroll dual-eligible beneficiaries who are older, Hispanic and from disadvantaged communities than regulated D-SNP plans, the study found. 

The study was written by researchers at Cambridge, Mass.-based Harvard University, the University of Pittsburgh and Washington University in St. Louis. 

Read the full study here. 

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