Medicare Advantage
From Families USA:
Buyer Beware: Higher Costs, More Confusion for the 2008 Part D Enrollment Season discusses several reasons why Part D enrollees, especially those with low incomes, should carefully examine their plans to see if the plans will continue to suit their needs. These reasons include rising premiums, the widening "doughnut hole," and other changes in coverage. (November 2007)
The CHAMP Act's Medicare Provisions Offer Real Help to Seniors and People with Disabilities discusses how this bill, passed by the House of Representatives on August 1, would level the playing field between traditional Medicare and private Medicare Advantage plans, improve benefits for beneficiaries, particularly for those with low incomes, and protect Medicare consumers. (September 2007)
Whose Advantage? Billions in Windfall Payments Go to Private Medicare Plans Medicare's private plans, now called Medicare Advantage plans, were supposed to save taxpayers money and provide better health care for beneficiaries. In reality, they are paid billions more than traditional Medicare while providing little, if anything, in the way of improved care. (June 2007)
Stop Bad Ideas—Private Gain and Public Pain in Medicare discusses how the push to privatize Medicare has resulted in landmark profits for the drug and insurance industries at the expense of taxpayers and Medicare beneficiaries. (December 2006)
Medicare Privatization: Windfall for the Special Interests examines how several decisions by Congress to promote privatized Medicare are costing taxpayers billions of dollars and bringing windfall profits to the insurance and drug industries. The report focuses on 1) overpayments to Medicare Advantage plans, 2) special funding for Medicare regional PPOs, and 3) prices obtained by Part D drug plans. (October 2006)
Top Dollar: CEO Compensation in Medicare's Private Insurance Plans | Families USA Press Release (June 2003)
Managed Care Plans Offer No Real Choice for Rural Medicare Beneficiaries (February 2003)
From the Center on Budget and Policy Priorities:
A proposal under consideration in Congress would help finance an expansion of children’s health coverage by reducing the overpayments to private health insurance companies that participate in Medicare. Insurance companies are waging an aggressive campaign to defend these overpayments, arguing that low-income and minority beneficiaries rely disproportionately on the private health plans in Medicare and that the overpayments are used to provide extra benefits not available through regular Medicare. Curbing Medicare Overpayments to Private Insurers Could Benefit Minorities and Help Expand Children’s Health Coverage argues that just the opposite may be true. (May 2007)
From The Commonwealth Fund:
Medicare Advantage Special Needs Plans for Dual Eligibles: A Primer identifies the core issues relating to the Medicare Modernization Act’s goal of offering full Medicare and Medicaid benefits through a single plan. The brief points out that coordination between special needs plans and state Medicaid programs often fails to occur. It also offers recommendations for providing higher quality care without institutionalization. (February 2008)
The Medicare Modernization Act (MMA) of 2003 sharply increased payments to private Medicare Advantage plans. The Cost of Privatization: Extra Payments to Medicare Advantage Plans—Updated and Revised indicates that private plans did not reduce Medicare costs in 2005 because MMA policies explicitly pay private plans more than traditional fee-for-service Medicare. In addition, these extra payments represent a potential source of funds that could be used to at least partially offset the costs of improved benefits for all Medicare enrollees. (December 2006)
Medicare Beneficiary Out-of-Pocket Costs: Are Medicare Advantage Plans a Better Deal? finds that, although costs for beneficiaries in good or fair health are lower in most Medicare plans when compared to fee-for-service-Medicare, beneficiaries in poor health have the potential to pay much more in annual out-of-pocket costs. (May 2006)
Trends in Medicare+Choice Benefits and Premiums, 1999-2002 examines broad trends in benefits and premiums since 1999 and analyzes 2002 benefit packages, focusing on changes that are likely to affect chronically ill beneficiaries who require more services. The authors also analyze the patterns in plan benefit and premium changes since 1999 and speculate about what these might reveal about health plan strategies. (November 2002)
Average Out-of-Pocket Health Care Costs for Medicare+Choice Enrollees Increase Substantially in 2002 updates an earlier report that focused on the period from 1999-2001. The Issue Brief finds that average out-of-pocket costs for Medicare+Choice enrollees in 2002 are up 24 percent from 2001 and 83 percent from 1999. The report also finds that enrollees in poor health faced the steepest cost increases.
(November 2002)
Medicare+Choice After Five Years: Lessons for Medicare's Future-Findings from Seven Major Cities examines the reasons why private health plans, health care providers, and beneficiaries are so widely dissatisfied with the M+C program. To do this, the authors reviewed the M+C program in seven cities that have varying payment rates and local health care structures, as follows: Cleveland, Houston, Long Island, Los Angeles, New York, Seattle, and Tucson. The authors also attempt to understand how the program could be stabilized. (September 2002)
Medicare+Choice 1999-2001: An Analysis of Managed Care Plan Withdrawals and Trends in Benefits and Premiums compares historical trends in benefits and premiums for plans that left the Medicare+Choice program in 2001 with those that stayed. The report also continues the Fund's analysis of trends in Medicare+Choice benefits and premiums to take into account the response to the Benefits Improvement and Performance Act of 2000 (BIPA) and the shifts in enrollment through March 2001. The authors conclude that "Medicare MCOs cannot provide a long-term solution to the fundamental deficiencies in Medicare's basic benefit package." (February 2002)
Out-of-Pocket Health Care Expenses for Medicare HMO Beneficiaries: Estimates by Health Status, 1999-2001 concludes that out-of-pocket spending by Medicare+Choice enrollees can be substantial, particularly for those in fair or poor health. The out-of-pocket estimates used in this report reflect four components of enrollee cost-sharing: Part B premiums; supplemental M+C premiums; spending for prescription drugs; and spending for other acute care services, such as emergency room visits. (February 2002)
The Fall 2001 edition of the "Commonwealth Fund Quarterly," a compilation of current work in health policy and practice, has been released. It includes a cover story on the Medicare+Choice program, as well as articles on the need for a Medicare drug benefit, problems women face when attempting to obtain health coverage, and the kinds of help small companies need to provide health coverage to their workers. (Fall 2001)
Medicare+Choice in 2000: Will Enrollees Spend More and Receive Less? This new report examines future prospects for Medicare+Choice, including how it is serving the needs of beneficiaries and implications for the future of Medicare. (July 2000)
From The General Accounting Office:
Medicare+Choice: Recent Payment Increases Had Little Effect on Benefits or Plan Availability in 2001 examines the role that the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) has played so far in stemming the tide of Medicare HMO departures. BIPA is the third in a series of increases in Medicare+Choice payments mandated by Congress, but the GAO found that the payment increases provided by BIPA "had little effect on the number of beneficiaries with access to at least one M+C plan in 2001" and that "it largely did not extend choice to beneficiaries who were not previously served by MCOs [managed care organizations]." The report also provides a brief history of this issue. (December 4, 2001)
From Health Affairs:
Beneficiaries who choose to remain in traditional fee-for-service Medicare are charged much higher monthly premiums for drug coverage, on average, than those enrolled in managed care plans, according to A First Look at the New Medicare Prescription Drug Plans. The article also reports that, while variations in cost-sharing and formularies provide beneficiaries with choices, they also make the system much more complex. (May 2006) SUBSCRIPTION REQUIRED
Medicare versus Private Insurance: Rhetoric and Reality compares the Medicare program to private insurance and finds that private insurance often suffers by comparison. For example, this 2001 survey demonstrates that Medicare beneficiaries report greater satisfaction with insurance coverage and with their access to care, and they report fewer instances of financial hardship resulting from medical bills.
(October 2002)
From The Kaiser Family Foundation:
Do We Know If Medicare Advantage Special Needs Plans Are Special? raises a question that researchers try to answer by looking at the history of special needs plans and the information that could help asses whether these plans perform differently from other Medicare Advantage plans. The report goes on to examine why companies establish the plans and the challenge of overseeing them. (January 2008)
A unique feature of the Medicare Part D drug program is the so-called “doughnut hole”—the gap in coverage. Medicare Part D 2008 Data Spotlight: The Coverage Gap examines the effect of the doughnut hole in Medicare stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans today, and it attempts to forecast what it could mean for beneficiaries in the future. (November 2007)
Medicare Part D Plan Characteristics, by State, 2008 Stand-Alone Prescription Drug Plans is a quick fact sheet that shows the number and type of prescription drug plans being offered in each state. (October 2007).
Tracking Medicare Health and Prescription Drug Plans Monthly Report for September 2007 charts the private plan offerings, enrollment status, and changes within Medicare Part D. (October 2007)
The Medicare Prescription Drug Benefit provides the latest information and data about the Medicare Part D program. These data include a breakdown of the standard benefit, updates on additional low-income assistance, and the latest 2006 enrollment data. (November 2006)
The Medicare Health and Prescription Drug Plan Tracker provides current and historical information about Medicare Advantage plans at the national, state, and county level. It includes such data as the numbers of eligible beneficiaries by county, breakdowns of Medicare managed care payment rates in different regions, as well as local data about the new Medicare stand-alone prescription drug plans (PDPs). (June 2006)
Premiums and Cost Sharing Features in Medicare’s New Prescription Drug Program, 2006 examines the premiums, deductibles, and selected cost-sharing features of Medicare Advantage prescription drug plans. It finds that Medicare Advantage plans, on average, charge less for drug coverage ($18 per month) than stand-alone drug plans ($37 per month). This is due in part to the fact that the government pays these plans more to participate in the program. (May 2006)
The Federal Employees Health Benefits Program (FEHBP) has recently been cited as a model for new Medicare prescription drug legislation. The Federal Employees Health Benefits Program: Program Design, Recent Performance, and Implications for Medicare Reform provides a basic description of the FEHBP structure, benefits, financing, and operations. It also discusses how FEHBP and Medicare compare in terms of benefits and health plan choices, whether the FEHBP model could provide savings for Medicare, how FEHBP compares to Medicare+Choice, and FEHBP's recent performance in terms of cost, benefit changes, and access to providers. (May 2003)
Medicare+Choice Withdrawals: Understanding Key Factors explores the reasons why M+C plans exited from or limited their participation in the program between 1999 and 2001. The report examines factors such as M+C payment levels, local market characteristics, and individual health plan characteristics to draw inferences about the types of plans and markets that have been most adversely affected. (June 2002)
Consumer Protection Issues in Medicare + Choice: this report describes and analyzes key Medicare+Choice provisions in the Balanced Budget Act and the accompanying regulations related to consumer protections. It also explores areas that could be strengthened to better serve the needs of the Medicare population. (December 1998)
From KaiserEDU.org:
Medicare Advantage: The Role of Private Health Plans in Medicare reviews the basics of Medicare Advantage and the different types of Medicare Advantage plans available. This tutorial presents trends in Medicare Advantage plan participation and enrollment, as well as characteristics of Medicare Advantage enrollees and a discussion of the impact that Medicare Advantage has had on traditional Medicare. (July 2007)
From Mathematica Policy Research, Inc.:
2006 Medicare Advantage Benefits and Premiums analyzes the benefits and premiums of Medicare Advantage plans in 2006, including trends in relation to prior years, differences by plan type, and the level of financial protection provided to beneficiaries by the diverse types of plans. (November 2006)
The role of private health plans in Medicare expanded substantially in 2004 under the new Medicare Modernization Act. Monitoring Medicare+Choice: What Have We Learned? Findings and Operational Lessons for Medicare Advantage notes that the program, now known as Medicare Advantage, is widely viewed as a failure. As private plans continue to be a focal point for changing Medicare in the future, policy makers need a better understanding of the dynamics of the system to facilitate a successful transition in this latest effort. (August 2004)
Medicare reform is at the top of the domestic policy agenda, and the role private plans will have in any reforms is a point of controversy. Average Out-of-Pocket Health Care Costs for Medicare+Choice Enrollees Increase 10 Percent in 2003 shows that M+C enrollees' out-of-pocket costs have doubled from where they stood just four years ago. This Issue Brief provides 2003 data for out-of-pocket spending by Medicare beneficiaries in M+C and other private plans, including the new PPO (preferred provider organization) demonstration plans. (August 2003)
Trends in Medicare+Choice Benefits and Premiums, 1999-2002 examines broad trends in benefits and premiums and analyzes 2002 benefit packages, focusing on changes that are likely to affect chronically ill beneficiaries who require more services. The report also analyzes patterns in plan benefit and premium changes since 1999 and speculates about what these patterns might reveal about health plan strategies. Among the key findings is that M+C plans continued to increase premiums and cost-sharing while scaling back benefits. (November 2002)
The Medicare+ Choice program, created by the Balanced Budget Act of 1997, aimed in part to expand the health plan options available to Medicare beneficiaries. A new fact sheet, Choice Continues to Erode in 2002, shows that choices continue to dwindle as more plans exit the program, benefits are eroding, and more seniors are returning to traditional fee-for-service Medicare. Although fewer enrollees will be directly affected by plan withdrawals in 2002 than in 2001, such withdrawals with still affect nearly 10 percent of beneficiaries this year. (January 2002)
Medicare + Choice Report Card: Mathematica Policy Research has released an interim report card on Medicare + Choice and has given it a D. This grade was based on the finding that the program has failed in several of its important goals, and that choices available to Medicare beneficiaries have actually diminished since its inception: some plans have withdrawn from the program, few new plans have entered the program, greater choice has not developed in areas that lacked choice, and the inequities in benefits and offerings between higher- and lower-income areas of the country have widened. (July/August 2001)
From the Medicare Rights Center:
Nearly 8.3 million of the 43 million Americans with Medicare receive their medical care through private insurance companies, also called Medicare Advantage (MA) plans. Too Good to Be True: The Fine Print in Medicare Private Health Plan Benefits examines the effectiveness of these plans and concludes that private plans often fail to deliver coverage that a patient could obtain from original Medicare. (April 2007)
From the National Health Policy Forum:
Medicare Advantage Payment Policy provides an overview of Medicare Advantage. It explains how plans are paid, reviews recent trends in plan participation and enrollment, and considers key issues raised by proposals to change the payment system. (September 2007)
From the New England Journal of Medicine:
Effect of Cost Sharing on Screening Mammography in Medicare Health Plans examines the rates at which women with cost-sharing in their Medicare managed care plans get mammograms. The data show that even relatively small copayments were associated with significantly lower mammography rates. (January 2008)
From Public Citizen:
Medicare Privatization: Bad for Seniors and People with Disabilities includes new information on the Bush Administration's PPO demonstration program (an attempt to introduce a new type of managed care plan into Medicare) and on HMO premiums and drug benefits for 2003. The report concludes that relying more heavily on private plans is not the approach to Medicare reform that is in the best interests of beneficiaries, nor is it what beneficiaries desire. Instead, the report recommends that the existing Medicare program be expanded to include prescription drug coverage. (February 2003)
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