Trends - Medicare advantage in 2006-2007: What congress intended?

Health Affairs

Volumn 26, Issue 4, 2007, Pages

  Gold, Marsha ^a  

^a MATHEMATICA POLICY RESEARCH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; ECONOMIC ASPECT; ECONOMICS; HEALTH CARE DELIVERY; HEALTH INSURANCE; HUMAN; LEGAL ASPECT; MEDICAL FEE; MEDICARE; ORGANIZATION AND MANAGEMENT; UNITED STATES; UTILIZATION REVIEW;

AGED; ECONOMIC COMPETITION; FEE-FOR-SERVICE PLANS; HEALTH SERVICES ACCESSIBILITY; HUMANS; MEDICARE; PREFERRED PROVIDER ORGANIZATIONS; PRIVATIZATION; UNITED STATES;

EID: 34548348568     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.4.w445     Document Type: Article

References (22)

1. M. Gold, "Private Plans in Medicare: Another Look," Health Affairs 24, no. 5 (2005): 1302-1310;
2. R.E. Hurley, B.C. Strunk, and J.M. Grossman, "Geography and Destiny: Local-Market Perspectives on Developing Medicare Advantage Regional Plans," Health Affairs 24, no. 4 (2005): 1014-1021;
3. B. Biles, G. Dallek, and L.H. Nicholas, "Medicare Advantage: Déjà Vu All Over Again?" Health Affairs 23 (2004): w586-w597 (published online 15 December 2004; 10.1377/hlthaff.w4.586);
4. and R.A. Berenson, "Medicare Disadvantaged and the Search for the Elusive 'Level Playing Field'," Health Affairs 23 (2004): w572-w585 (published online 15 December 2004; 10.1377/hlthaff.w4.572).
5. J. Cubanski and P. Neuman, "Status Report on Medicare Part D Enrollment in 2006: Analysis of Plan-Specific Market Share and Coverage," Health Affairs 26, no. 1 (2007): w1-w12 (published online 21 November 2006; 10.1377/hlthaff.26.1.w1);
6. and Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy (Washington: MedPAC, March 2007).
7. MedPAC, Report to the Congress: Increasing the Value of Medicare (Washington: MedPAC, June 2006).
8. MMA also made other changes, including authorizing special-needs plans and medical savings account plans, but they are not central to this paper. See Gold, "Private Plans in Medicare";
9. and M. Gold, "Private Plans in Medicare: A 2007 Update" (Washington: Henry J. Kaiser Family Foundation, March 2007).
10. Payment rates to plans vary with the county a beneficiary lives in, but this should be invisible to beneficiaries.
11. These included special provisions relating to payments in areas with a single "essential hospital," fewer quality requirements, and network adequacy assessments that allow plans to address network limitations by paying in-network rates to nonnetwork providers in selected circumstances. MMA also includes a Stabilization Fund to encourage and retain R-PPOs beginning in 2007.
12. MedPAC, "Update on Medicare Private Plans," chap. 4 in Report to the Congress (March 2007).
13. J. Blum, R. Brown, and M. Frieder, "An Examination of Medicare Private Fee-for-Service Plans" (Washington: Kaiser Family Foundation, March 2007).
14. M. Gold, "Medicare's Private Fee-for-Service Plan: Sterling's Structure, Opportunities and Risks," Operational Insights no. 4 (Washington: Mathematica Policy Research Inc., July 2001).
15. M. Gold and L. Achman, "Medicare's Experience with PPOs and Private Fee-for-Service Plans," Operational Insights no. 12 (Washington: MPR Inc., October 2003).
16. Data presented in M. Gold and S. Peterson, "Analysis of the Characteristics of Medicare Advantage Plan Participation," Report prepared for the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (Washington: MPR Inc., 2006).
17. MedPAC, Report to the Congress (March 2007), 246, Figure 4.1 and related text.
18. MA offerings change in January of each year. We measured enrollment in March rather than January because it takes a few months for the data to "settle down."
19. Centers for Medicare and Medicaid Services, Medicare Advantage/Part D Contract and Enrollment Data, "Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report - Monthly Summary Report (Data as of April 2007)" (Baltimore: CMS, April 2007).
20. M. Gold, "Premiums and Cost-Sharing Features in Medicare's New Prescription Drug Program, 2006" (Washington: Kaiser Family Foundation, May 2006).
21. D. Lipschutz, P. Precht, and B. Burns, "After the Goldrush: The Marketing of Medicare Advantage and Part D Plans" (Sacramento: California Health Advocates and Medicare Rights Center, January 2007).
22. Ibid.