The Veterans Health Administration has spent $78 billion from 2011 to 2020 on U.S. military veterans enrolled in Medicare Advantage plans, sparking concerns about potential federal overpayments to these private plans. A recent analysis by researchers from Brown University and the Providence Veterans Affairs Medical Center, published in JAMA, highlights the issue of dual enrollment of veterans leading to unnecessary federal spending.
Medicare Advantage plans receive fixed per-patient payments for health care services, regardless of whether veterans receive care through the Veterans Health Administration. This dual enrollment system could result in the government paying twice for the same beneficiaries’ care. David Meyers, an assistant professor at Brown University’s School of Public Health, points out that these overpayments could lead to significant additional spending by the federal government.
The Medicare Advantage program, the privately run arm of the Medicare program, has seen significant growth in recent years. The number of military veterans utilizing Veterans Health Administration services increased by 63% from 2011 to 2020. The researchers used Veterans Health Administration enrollment data to identify veterans dually covered by Medicare Advantage and the VHA, finding that the VHA paid over $78 billion for health services during this period.
Meyers suggests two solutions to address the overpayment issue: reducing payments to Medicare Advantage plans for beneficiaries with VHA coverage or allowing the VHA to seek reimbursement from the Medicare plan. The latter option seems more feasible, as veterans would still receive coverage regardless of where they seek care.
Under Section 1862 of the Social Security Act, care provided by the VA and other governmental entities is not covered under Medicare, and the VA does not seek reimbursement from Medicare or Medicare Advantage plans. However, Meyers argues that there should be an opportunity for the VHA to seek reimbursement from Medicare to ensure adequate care for veterans.
The authors plan to conduct further research to determine the exact amount of duplicate spending. Dr. Amal Trivedi, a professor at Brown University and physician at the Providence VA Medical Center, leads the larger study focusing on the implications of veterans’ enrollment in Medicare Advantage on federal spending.
The study, titled “Spending by the Veterans Health Administration for Medicare Advantage Dual Enrollees, 2011-2020,” was published in JAMA. It sheds light on the need to understand the impact of veterans’ enrollment in Medicare Advantage on federal spending. The findings underscore the importance of addressing potential overpayments to ensure efficient use of government resources.
As the research continues, it will be crucial to develop strategies that optimize spending while providing quality care for veterans. The collaboration between Brown University and the Providence VA Medical Center exemplifies ongoing efforts to improve healthcare delivery for our nation’s military veterans.
