Analyzing Medicare Advantage Cost-Sharing for Cardiac Rehabilitation Services

By: Daniella Pena

This summer I worked on a research project analyzing Medicare Advantage (MA) cost-sharing for cardiac rehabilitation services. These services are focused on helping heart attack survivors and other patients with severe cardiovascular disease resume normal functioning after a cardiovascular event. The main component of cardiac rehabilitation is exercise training, but nutritional education and counseling have been incorporated in recent years. Life expectancies greatly increase when patients participate in these programs, and their risk of having another heart attack is significantly lowered. However, very few patients who are eligible for these services participate in cardiac rehabilitation. A common theory and concern as to why this was the case was high cost-sharing amongst MA plans that cover these services. Medicare is often the only insurance that typical patients needing these services have, therefore if the out of pocket expenses associated with receiving these services was too high they might choose to forgo this treatment. Therefore, my project focused on analyzing the different cost-sharing requirements across MA plans and compared these amounts to the nondiscriminatory cost-sharing limits set by CMS. I used R Studio to analyze data from the years 2016-2020 and my main findings were as follows: copay amounts for cardiac rehabilitation services and intensive cardiac rehabilitation services averaged $25 although these plans could have charged up to $50 and $100 respectively, coinsurance remained constant at 18% for all services types throughout this time frame. These results indicate that cost-sharing is set lower than considered necessary to make these services affordable for patients. Therefore, there are other barriers to treatment that are causing few patients to enroll in these programs. As we learned throughout the summer, there are a lot of factors that affect health, and racial disparities are very common in medicine. Minorities are likely to have lower incomes and therefore reduced access to nutritious foods and health care, which contribute strongly to the negative health outcomes observed in these populations. This is a widespread and persistent problem that severely needs to be addressed, and we’ve had the opportunity to meet and work with people who are well aware of these issues and trying their best to do everything in their power to help in whatever way they can. We’ve had a lot of presentations that outline these disparities and factors that contribute to the inequality observed in health care, so in learning that I’ve personally begun to view everything through a different lense. I have started to look more deeply into the numbers, but also possible explanations for those numbers, and I’ve put a picture together of what those numbers represent. My critical thinking skills have evolved a lot, and I feel that I can thoroughly analyze problems with a few different perspectives instead of one. I plan to use all that I’ve learned about health disparities to inform policies I hope to write one day. This has been an enriching experience, and I hope to continue exploring the topics covered, while also thinking of ways to address these problems on a large scale.

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