Medicare advantage: Déjà Vu all over again?

Health Affairs

Volumn 23, Issue SUPPL. 2, 2004, Pages

  Biles, Brian ^a   Dallek, Geraldine ^b   Nicholas, Lauren Hersch ^a  

^a GEORGE WASHINGTON UNIVERSITY   (United States)

^b Columbia University ^*

Author keywords

[No Author keywords available]

Indexed keywords

DRUG LEGISLATION; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH PROGRAM; HUMAN; MEDICARE; PRESCRIPTION; REVIEW; AGED; ARTICLE; INSURANCE; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT; UNITED STATES;

AGED; HUMANS; INSURANCE COVERAGE; INSURANCE, PHARMACEUTICAL SERVICES; MEDICARE PART C; UNITED STATES;

EID: 17144369227     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.W4.586     Document Type: Review

References (46)

1. If two full-risk plans are not available in a region, the HHS secretary may contract with a "limited risk plan" or, if none is available, a "fallback" plan to manage the prescription drug benefit.
2. Y. Berra, "Yogi-isms," 2004, www.yogi-berra.com/yogiisms.html (9 August 2004).
3. G. Dallek and C. Edwards, Restoring Choice to Medicare+Choice: The Importance of Standardizing Health Plan Benefit Packages (New York: Commonwealth Fund, October 2001).
4. Henry J. Kaiser Family Foundation, Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Menlo Park, Calif.: Kaiser Family Foundation, December 2003).
5. In 2004, eleven M+C plans in Los Angeles County, California, offered twenty different options; in Miami - Dade County, Florida, nine M+C plans offered twenty-one options; and in New York City (Queens), eleven plans offered thirty options. Medicare Personal Care Plan Finder, www.medicare.gov (2 February 2004).
6. J. Hibbard et al., "Is the Informed-Choice Policy Approach Appropriate for Medicare Beneficiaries?" Health Affairs 20, no. 3 (2001): 199-203; and J. Hibbard et al., "Can Medicare Beneficiaries Make Informed Choices?" Health Affairs 17, no. 6 (1998): 181-193.
7. J. Hibbard et al., "Is the Informed-Choice Policy Approach Appropriate for Medicare Beneficiaries?" Health Affairs 20, no. 3 (2001): 199-203; and J. Hibbard et al., "Can Medicare Beneficiaries Make Informed Choices?" Health Affairs 17, no. 6 (1998): 181-193.
8. U.S. Government Accountability Office, Medigap Insurance: Better Consumer Protection Should Result from 1990 Changes to Baucus Amendment, Pub. no. GAO/HRD-91-49 (Washington: GAO, March 1991).
9. B. Schwartz, "A Nation of Second Guesses," New York Times, 22 January 2004.
10. M. Moon and M. Storeygard, One-Third at Risk, 2001: Medicare Beneficiaries with Health Problems Need Cost Protections (New York: Commonwealth Fund, September 2001).
11. M. Freudenheim, "Drug Discount Card for Elderly May Confuse as Well as Help," New York Times, 7 February 2004.
12. For a discussion of HICAP funding, see B. Vladeck and B. Cooper, Making Medicare Work Better (New York: Mount Sinai Institute for Medicare Practice, March 2001).
13. Dan L. Crippen, director, Congressional Budget Office, "Disease Management in Medicare: Data Analysis and Benefit Design Issues," Testimony before the U.S. Senate Special Committee on Aging, 19 September 2002, www.cbo.gov/showdoc.cfm?index=3776&sequence=0 (2 February 2004).
14. Kaiser Family Foundation, Medicare and Prescription Drug Spending Chartpack (Washington: Kaiser Family Foundation, June 2003).
15. Centers for Medicare and Medicaid Services, "Note to: Medicare Advantage Organizations and Other Interested Parties: Revised Medicare Advantage Payment Rates for Calendar Year (CY) 2004," 16 January 2004, cms.hhs.gov/healthplans/rates/2004ma/cover.asp (2 February 2004).
16. Centers for Medicare and Medicaid Services, "Forty-five Day Notice for MA Rates," 17 September 2004, cms.hhs.gov/healthplans/rates/2005/45day- cover.asp (10 November 2004).
17. G. Dallek, B. Biles, and L.H. Nicholas, "Lessons from Medicare+Choice for Medicare Reform," Issue Brief (New York: Commonwealth Fund, June 2003).
18. L. Achman and M. Gold, Medicare+Choice Plans Continue to Shift More Costs to Enrollees (New York: Commonwealth Fund, April 2003).
19. M. Gold and L. Achman, "Average Out-of-Pocket Health Care Costs for Medicare+Choice Enrollees Increase 10 Percent in 2003," Issue Brief (New York: Commonwealth Fund, August 2003).
20. G. Dallek, A. Dennington, and B. Biles, Geographic Inequity in Medicare+Choice: Findings from Seven Communities (New York: Commonwealth Fund, September 2002).
21. Gold and Achman, "Average Out-of-Pocket Health Care Costs."
22. Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Sec. 1860D-11(e)(2)(D).
23. L. Achman and M. Gold, Medicare+Choice 1999-2001: An Analysis of Managed Care Plan Withdrawals and Trends in Benefits and Premiums (New York: Commonwealth Fund, January 2002).
24. I b i d.
25. CBO, A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit (Washington: CBO, July 2004).
26. Ibid.; and K. Levit et al., "Health Spending Rebound Continues in 2002," Health Affairs 23, no. 1 (2004): 147-159.
27. Ibid.; and K. Levit et al., "Health Spending Rebound Continues in 2002," Health Affairs 23, no. 1 (2004): 147-159.
28. CMS, Medicare Personal Plan Finder at www.medicare.gov (2 February 2004).
29. G. Dallek and A. Dennington, Physician Withdrawals: A Major Source of Instability in the Medicare+Choice Program (New York: Commonwealth Fund, January 2002).
30. Dallek et al., Geographic Inequity in Medicare+Choice.
31. CMS, "Review Shows Beneficiaries in Medicare Advantage Plans Will See Better Benefits, Lower Costs," CMS News, 27 February 2004.
32. M. Gluck, Medicare Chart Book, 2d ed. (Menlo Park, Calif.: Kaiser Foundation, Fall 2001), 52.
33. M. Moon, B. Gage, and A. Evans, "An Examination of Key Medicare Provisions in the Balanced Budget Act of 1997," Briefing Note, September 1997, www.cmwf.org/publications/publications_show.htm?doc_id= 221424 (29 November 2004).
34. G. Dallek, B. Biles, and A. Dennington, "The 2002 Medicare+Choice Plan Lock-In: Should It Be Delayed?" Issue Brief (New York: Commonwealth Fund, December 2001).
35. Medicare beneficiaries who choose not to enroll in an MA-PD or PDP or who drop their plan and later opt to join will pay a penalty of at least 1 percent of premiums for every month they have no alternative "credible" coverage.
36. B. Biles, L. Nicholas, and B. Cooper, "The Cost of Privatization: Extra Payments to Medicare Advantage Plans," Issue Brief (New York: Commonwealth Fund, May 2004).
37. For example, Seattle M+C enrollees in good health would expect to pay 2.7 times as much out of pocket as enrollees in Los Angeles would pay. Dallek et al., Geographic Inequity in Medicare+Choice.
38. CMS, "Medicare Advantage Payment Rates Information," 17 September 2004, cms.hhs.gov/healthplans/ rates (10 November 2004); and CMS, Medicare Managed Care Market Penetration for All Medicare Plan Contractors - Quarterly State/County Data Files," 21 October 2004, cms.hhs.gov/ healthplans/statistics/ mpsct/default.asp? (10 November 2004).
39. CMS, "Medicare Advantage Payment Rates Information," 17 September 2004, cms.hhs.gov/healthplans/ rates (10 November 2004); and CMS, Medicare Managed Care Market Penetration for All Medicare Plan Contractors - Quarterly State/County Data Files," 21 October 2004, cms.hhs.gov/ healthplans/statistics/ mpsct/default.asp? (10 November 2004).
40. Biles et al., "The Cost of Privatization."
41. Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy (Washington: MedPAC, March 2003), 195-197.
42. Biles et al., "The Cost of Privatization."
43. CMS, "Note to: Medicare Advantage Organizations and Other Interested Parties; Subject: Announcement of Calendar Year 2005 Medicare Advantage Payment Rates," cms.hhs.gov/healthplans/rates/2005/cover .asp (17 September 2004).
44. MedPAC, Report to the Congress, 205-219.
45. R. Berenson, "Medicare+Choice: Doubling or Disappearing?" Health Affairs, 28 November 2001, content .healthaffairs.org/cgi/content/ abstract/hlthaff.w1.65 (10 November 2004).
46. Henry J. Kaiser Family Foundation, Medicare+Choice Fact Sheet (Washington: Kaiser Family Foundation, April 2003).