A new study reveals that from 2011 to 2020, the Veterans Health Administration (VHA) spent $78 billion caring for veterans also enrolled in Medicare Advantage plans. This dual coverage raises concerns about potential federal overpayments.
Summary: Research shows the federal government may be paying twice for care of veterans enrolled in both Medicare Advantage and the Veterans Health Administration, potentially leading to billions in unnecessary spending.
Estimated reading time: 4 minutes
A recent analysis by researchers from Brown University and the Providence Veterans Affairs Medical Center has uncovered a significant overlap in federal healthcare spending. The study, published in JAMA, found that the Veterans Health Administration (VHA) spent $78 billion from 2011 to 2020 on care for U.S. military veterans who were also enrolled in Medicare Advantage plans.
This dual enrollment scenario has sparked concerns about potential overpayments by the federal government. The crux of the issue lies in how Medicare Advantage plans receive fixed per-patient payments for health services, regardless of whether veterans receive care through the VHA.
The Dual Enrollment Dilemma
David Meyers, an assistant professor of health services, policy and practice at Brown University’s School of Public Health and lead author of the study, explains the problem: “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.”
The Medicare Advantage program, the privately run arm of Medicare, has seen rapid growth in recent years. Concurrently, the number of military veterans using VHA services increased by 63% from 634,470 in 2011 to 1,033,643 in 2020. This growth in both programs has amplified the potential for overlapping coverage and expenditure.
Financial Implications and Proposed Solutions
The study’s findings suggest that these potential overpayments could result in substantial additional spending by the federal government. To address this issue, Meyers proposes two potential solutions:
- Reduce the payments Medicare Advantage plans receive for beneficiaries with VHA coverage.
- Allow the VHA to seek reimbursement from the Medicare plan.
Meyers favors the reimbursement approach, stating, “There should be an opportunity for the Veterans Health Administration to seek reimbursement from Medicare in order to be able to afford to deliver the care that veterans need and deserve.”
Current Regulations and Future Research
It’s important to note that under Section 1862 of the Social Security Act, care provided by VA and other governmental entities (with certain exceptions) is not covered under Medicare. Currently, VA does not seek reimbursement from Medicare or Medicare Advantage plans. However, VA does bill private health insurance for certain non-service-connected medical care provided to veterans.
The researchers aim to conduct additional studies to determine the precise amount of duplicate spending. Dr. Amal Trivedi, a Brown University professor and physician at the Providence V.A. Medical Center, who leads the larger study of which this analysis is a part, emphasizes the need for further research: “This study highlights the need to further understand the implications of veterans enrollment in Medicare Advantage on potentially duplicative federal spending.”
Addressing Potential Concerns
Some may question whether this dual enrollment actually benefits veterans by providing more comprehensive coverage. While it’s true that veterans may have more options for care, the issue at hand is the efficient use of federal funds. If the government is indeed paying twice for the same potential services, it could lead to unnecessary strain on healthcare budgets.
Others might wonder about the impact on veterans’ care if changes are made to the current system. It’s crucial to note that any proposed solutions, such as allowing the VHA to seek reimbursement from Medicare plans, are aimed at optimizing federal spending without compromising the quality or availability of care for veterans.
As the healthcare landscape continues to evolve, studies like this one play a vital role in identifying areas for improvement in how we finance and deliver care to those who have served our country.
Quiz: Test Your Knowledge on Veterans’ Healthcare Spending
- How much did the Veterans Health Administration spend on care for Medicare Advantage enrollees from 2011 to 2020? a) $50 billion b) $78 billion c) $100 billion d) $120 billion
- What percentage increase was there in veterans using VHA services from 2011 to 2020? a) 33% b) 53% c) 63% d) 73%
- Which of the following is NOT a proposed solution to address potential overpayments? a) Reduce payments to Medicare Advantage plans for VHA-covered beneficiaries b) Allow VHA to seek reimbursement from Medicare plans c) Increase funding for the Veterans Health Administration d) Bill private health insurance for certain non-service-connected medical care
Answers:
- b) $78 billion
- c) 63%
- c) Increase funding for the Veterans Health Administration
Further Reading
- JAMA Article: Spending by the Veterans Health Administration for Medicare Advantage Dual Enrollees, 2011-2020
- Veterans Health Administration Official Website
- Medicare Advantage Program Information
Glossary of Terms
- Veterans Health Administration (VHA): The largest integrated health care system in the United States, providing care to U.S. military veterans.
- Medicare Advantage: A type of Medicare health plan offered by private companies that contract with Medicare to provide all Part A and Part B benefits.
- Dual Enrollment: When an individual is enrolled in two different health insurance plans simultaneously.
- Reimbursement: The act of paying back money to someone who has spent it on your behalf.
- Non-service-connected Medical Care: Healthcare provided to veterans for conditions not directly related to their military service.
- Federal Overpayment: When the federal government pays more than necessary for a service or benefit.
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