Government often pays twice for veterans in federal health plans

The federal government often pays for the same services twice for veterans enrolled in both the Medicare Advantage plan and the Veterans Affairs health care system, researchers from Brown University suggest.

“In this scenario, private Medicare plans receive taxpayer-funded subsides to insure veterans who in turn use another government-funded health system to receive medical care,” the researchers wrote. “Given the severe financial pressure confronting the Medicare program and the federal budget, the nature and extent of services provided to these beneficiaries and the amount of duplicate payments for them should be quantified.”

The researchers identified veterans with at least 1 month of simultaneous enrollment in the VA and a Medicare Advantage (MA) plan. They linked VA data from 2004 to 2009 to MA data obtained from the Medicare Health Effectiveness Data and Information Set, which all MA plans are required to report to.

The primary study population included 1,066,750 veterans who were simultaneously enrolled in the VA and an MA plan. In 2004, there were 485,651 dual enrollees, which increased to 924,792 in 2006. 

During the 6-year period from 2004 to 2009, the total estimated cost of VA care for MA enrollees was $13 billion. In 2004, the costs were estimated to be $1.3 billion, and in 2005, the costs were estimated to be $3.2 billion. The largest amount of spending was for outpatient care, followed by acute and post-acute care and prescription drugs.

Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services and 35% exclusively used the MA plan, whereas 50% used both. The VA paid for 44% of outpatient visits, 15% of acute medical and surgical admissions and 18% of acute medical and surgical hospital days. The VA requested $52.3 million from private insurers for MA enrollees, and collected $9.4 million.

“In light of the severe financial pressure facing the Medicare program, policymakers should consider measures to identify and eliminate these potentially redundant expenditures,” the researchers wrote.

For more information:

Trivedi AN. JAMA. 2012;doi:10.1001/jama.2012.7115.

Disclosure: The researchers report financial relationships with Abt Associates Inc., HCRManorCare, Humana, Pfizer, PointRight, Navi-Health and RAND Corporation.

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