ABSTRACT Medicare reform is at the top of the domestic policy agenda, and the role of private pla... more ABSTRACT Medicare reform is at the top of the domestic policy agenda, and the role of private plans in that reform is a critical factor. Most of Medicare's experience with private plans has involved the Medicare+Choice (M+C) program. M+C plans, primarily HMOs, receive capitated payments and provide coverage for Medicare-covered services. To the extent that plans have any savings left over, they offer additional benefits. Because Medicare requires substantial cost-sharing by its beneficiaries and excludes coverage for important elements of care, such as prescription drugs, the extra benefits provided by M+C plans have been important in reducing enrollees' out-of-pocket costs. However, the average M+C enrollee is spending about $1,964 out-of-pocket this year, rising 10 percent from last year and doubling from 4 years ago. An enrollee in relatively poor health spends even more. This issue brief provides data for 2003 on out-of-pocket spending by Medicare beneficiaries in M+C and other private plans, including the new preferred provider organization (PPO) demonstrations.
This report from a series on benefits and premiums in Medicare+Choice plans updates existing anal... more This report from a series on benefits and premiums in Medicare+Choice plans updates existing analyses of trends from 1999 to reflect 2003 changes. It also looks at the scope of benefits available nationally, geographic variation, benefits and premiums in PPO demonstration plans, and the experience of Part B refund plans in their first year. Finds that monthly premiums in M+C continued to increase, though not as much as in 2002; the percent of enrollees with any prescription drug coverage declined slightly; and cost-sharing at point-of-service has increased steadily over the past three years.
Reviews the early effects of the Benefits Improvement and Protection Act, which raised payment ra... more Reviews the early effects of the Benefits Improvement and Protection Act, which raised payment rates as of March 2001. Notes that only a few plans re-entered but those that did had important roles in their markets. As time goes on, effects are more likely to be seen in urban areas, since the payment increases, while significant, may not be enough to encourage substantial new entry of Medicare HMOs into rural and less urbanized areas, where managed care is limited by diseconomies of scale and provider resistance.
In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the pr... more In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the program, and monthly premiums and cost sharing rose in the remaining plans. In anticipation of an expanded role for private plans in 2006, the Medicare Modernization Act attempted to stabilize the program by authorizing additional payment increases for Medicare Advantage (formerly Medicare+Choice) plans in 2004, above what they were already slated to receive. This new paper profiles how Medicare payments to plans will change across the country, as well as the policy changes underlying the shift.
This analysis of trends in benefits and premiums since 1999 in the Medicare+Choice program reveal... more This analysis of trends in benefits and premiums since 1999 in the Medicare+Choice program reveals that plans have continued to raise premiums and beneficiaries’ cost-sharing, while at the same time limiting coverage of supplemental benefits, such as prescription drug coverage. Monthly premiums for enrollees average $37, up from $32 in 2002, and $23 in 2001. The percent of enrollees with drug coverage is slightly down to 69 percent from 72 percent in 2002.
Reveals continued growth in premiums in 2001 and a simultaneous continued decline in benefit comp... more Reveals continued growth in premiums in 2001 and a simultaneous continued decline in benefit comprehensiveness. Whether the erosion will persist remains to be seen. For copies, call 212-606-3800.
Notes that most state high-risk insurance pools provide access to health insurance for few of tho... more Notes that most state high-risk insurance pools provide access to health insurance for few of those denied coverage in the private market. High premiums, limited benefit packages, and waiting periods limited access. In addition, some states' pools are closed to new enrollees or have long waiting lists, and the existence of pools is rarely publicized. Available from the Commonwealth Fund at 1-888-777-2744.
The MedicareChoice program was created to expand choice and encourage beneficiaries to more activ... more The MedicareChoice program was created to expand choice and encourage beneficiaries to more actively consider the choices they have. This article assesses how "salient" choice is to Medicare beneficiaries. More than half of all Medicare beneficiaries in 2000 reported that they either have never considered their options to join a Medicare HMO or get supplemental coverage (44 percent) or did so last when they first became Medicare eligible (14 percent). Overall, 14 percent of Medicare beneficiaries found choice salient in 2000. Those new to Medicare or forced to switch because their plan left the program were more likely to consider choice, as expected. The multi-variate analysis shows that existing HMO enrollment is most strongly associated with salience of choice and also that this effect operates especially in the individual market. The findings of this research are consistent with the literature in highlighting the limited salience of choice to Medicare beneficiaries and...
ABSTRACT Medicare reform is at the top of the domestic policy agenda, and the role of private pla... more ABSTRACT Medicare reform is at the top of the domestic policy agenda, and the role of private plans in that reform is a critical factor. Most of Medicare's experience with private plans has involved the Medicare+Choice (M+C) program. M+C plans, primarily HMOs, receive capitated payments and provide coverage for Medicare-covered services. To the extent that plans have any savings left over, they offer additional benefits. Because Medicare requires substantial cost-sharing by its beneficiaries and excludes coverage for important elements of care, such as prescription drugs, the extra benefits provided by M+C plans have been important in reducing enrollees' out-of-pocket costs. However, the average M+C enrollee is spending about $1,964 out-of-pocket this year, rising 10 percent from last year and doubling from 4 years ago. An enrollee in relatively poor health spends even more. This issue brief provides data for 2003 on out-of-pocket spending by Medicare beneficiaries in M+C and other private plans, including the new preferred provider organization (PPO) demonstrations.
This report from a series on benefits and premiums in Medicare+Choice plans updates existing anal... more This report from a series on benefits and premiums in Medicare+Choice plans updates existing analyses of trends from 1999 to reflect 2003 changes. It also looks at the scope of benefits available nationally, geographic variation, benefits and premiums in PPO demonstration plans, and the experience of Part B refund plans in their first year. Finds that monthly premiums in M+C continued to increase, though not as much as in 2002; the percent of enrollees with any prescription drug coverage declined slightly; and cost-sharing at point-of-service has increased steadily over the past three years.
Reviews the early effects of the Benefits Improvement and Protection Act, which raised payment ra... more Reviews the early effects of the Benefits Improvement and Protection Act, which raised payment rates as of March 2001. Notes that only a few plans re-entered but those that did had important roles in their markets. As time goes on, effects are more likely to be seen in urban areas, since the payment increases, while significant, may not be enough to encourage substantial new entry of Medicare HMOs into rural and less urbanized areas, where managed care is limited by diseconomies of scale and provider resistance.
In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the pr... more In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the program, and monthly premiums and cost sharing rose in the remaining plans. In anticipation of an expanded role for private plans in 2006, the Medicare Modernization Act attempted to stabilize the program by authorizing additional payment increases for Medicare Advantage (formerly Medicare+Choice) plans in 2004, above what they were already slated to receive. This new paper profiles how Medicare payments to plans will change across the country, as well as the policy changes underlying the shift.
This analysis of trends in benefits and premiums since 1999 in the Medicare+Choice program reveal... more This analysis of trends in benefits and premiums since 1999 in the Medicare+Choice program reveals that plans have continued to raise premiums and beneficiaries’ cost-sharing, while at the same time limiting coverage of supplemental benefits, such as prescription drug coverage. Monthly premiums for enrollees average $37, up from $32 in 2002, and $23 in 2001. The percent of enrollees with drug coverage is slightly down to 69 percent from 72 percent in 2002.
Reveals continued growth in premiums in 2001 and a simultaneous continued decline in benefit comp... more Reveals continued growth in premiums in 2001 and a simultaneous continued decline in benefit comprehensiveness. Whether the erosion will persist remains to be seen. For copies, call 212-606-3800.
Notes that most state high-risk insurance pools provide access to health insurance for few of tho... more Notes that most state high-risk insurance pools provide access to health insurance for few of those denied coverage in the private market. High premiums, limited benefit packages, and waiting periods limited access. In addition, some states' pools are closed to new enrollees or have long waiting lists, and the existence of pools is rarely publicized. Available from the Commonwealth Fund at 1-888-777-2744.
The MedicareChoice program was created to expand choice and encourage beneficiaries to more activ... more The MedicareChoice program was created to expand choice and encourage beneficiaries to more actively consider the choices they have. This article assesses how "salient" choice is to Medicare beneficiaries. More than half of all Medicare beneficiaries in 2000 reported that they either have never considered their options to join a Medicare HMO or get supplemental coverage (44 percent) or did so last when they first became Medicare eligible (14 percent). Overall, 14 percent of Medicare beneficiaries found choice salient in 2000. Those new to Medicare or forced to switch because their plan left the program were more likely to consider choice, as expected. The multi-variate analysis shows that existing HMO enrollment is most strongly associated with salience of choice and also that this effect operates especially in the individual market. The findings of this research are consistent with the literature in highlighting the limited salience of choice to Medicare beneficiaries and...
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