Medicare's private plans: A report card on medicare advantage

Health Affairs

Volumn 28, Issue 1, 2009, Pages

  Gold, Marsha ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH CARE QUALITY; MEDICARE; MONITORING; PERFORMANCE; PRESCRIPTION;

CONTRACTS; DATABASES AS TOPIC; INSURANCE COVERAGE; INTERVIEWS AS TOPIC; MEDICARE PART C; PRIVATE SECTOR; PROGRAM EVALUATION; UNITED STATES;

EID: 59449101795     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.28.1.w41     Document Type: Article

References (42)

1. See M. Gold, "Medicare Advantage in 2006-2007: What Congress Intended?" Health Affairs 26, no. 4 (2007): w445-w455 (published online 15 May 2007; 10.1377/hlthaff.26.4.w445).
2. J.K. Iglehart, "Medicare Showdown," New England Journal of Medicine 359, no. 6 (2008): 556-558;
3. and J.K. Iglehart, "The New Medicare Prescription-Drug Benefit - A Pure Power Play," New England Journal of Medicine 350, no. 8 (2004): 826-833.
4. Cost contracts, demonstrations, and a few other types of contracts are separately authorized and not technically part of MA. Because the distinction likely is invisible to beneficiaries and these contracts are important in certain markets, we include them here. HR 6331 phases out payment to MA plans for the indirect costs of graduate medical education. Effective in 2010, PFFS plans must establish provider networks for individual and group products except in counties where two or fewer plans operate. MIPPA also modifies SNP provisions and expands requirements for HEDIS reporting to all MA plans.
5. S. Keehan et al., "Health Spending Projections through 2017: The Baby-Boom Generation Is Coming to Medicare," Health Affairs 27, no. 2 (2008): w145-w155 (published online 26 February 2008; 10.1377/hlthaff.27.2. w145).
6. M. Gold et al., "Monitoring Medicare+Choice: What Have We Learned? Findings and Operational Lessons for Medicare Advantage" (Washington: Mathematica Policy Research, August 2004).
7. M. Gold, "Medicare+Choice: An Interim Report Card," Health Affairs 20, no. 4 (2001): 120-138.
8. M. Gold, "Private Plans in Medicare: Another Look," Health Affairs 24, no. 5 (2005): 1302-1310.
9. Gold, "Medicare Advantage in 2006-2007." 9. Most contracts offer more than one plan, the unit that defines eligibility (for example, group, SNP, other) and the benefit package. Contract service areas also can be divided into aggregations of counties, each with unique plans. (This is not allowed within regions for RPPOs.)
10. Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy (Washington: MedPAC, March 2008);
11. Gold, "Medicare Advantage in 2006-2007"; M. Gold, "Medicare Advantage in 2008" (Washington: Henry J. Kaiser Family Foundation, June 2008);
12. Gold, "Medicare+Choice";
13. and Gold et al., "Monitoring Medicare+Choice."
14. MSAs have high deductibles accompanied by an annual deposit in an interest-bearing checking account that can be used to cover qualified medical expenses. MSAs do not provide drug coverage, but beneficiaries can purchase it through a PDP. MSAs have been available since 2007 (mainly through WellPoint).
15. Gold, "Medicare Advantage in 2008." 13. Ibid.
16. Gold, "Medicare Advantage in 2006-2007";
17. and J.R. Blum, R. Brown, and M. Frieder, "An Examination of Medicare Private Fee-for-Service Plans" (Washington: Kaiser Family Foundation, March 2007).
18. MedPAC, Report to the Congress: Medicare Payment Policy.
19. In July 2007, there were about 1.0 million people in group HMOs or cost plans, 50 percent in contracts that began before 1990, and 25 percent in plans starting between 1990 and 1999. The same number - about 1 million - were enrolled in 2008.
20. E.C. McNichol, "Accounting for the Cost of Retiree Health and Other Benefits (GASB 45)" (Washington: Center on Budget and Policy Priorities, March 2008). Under the Financial Accounting Standards Board Statement 106, private employers had to do such accounting starting in 1993.
21. See Centers for Medicare and Medicaid Services, "Part D Waiver Guidance for Employer/Union Retiree Coverage," 4 January 2006, http://www.cms.hhs.gov/EmpGrpWaivers/Downloads/PartDWaiverGuidance02112005.pdf (accessed 3 July 2008).
22. Gold, "Medicare Advantage in 2008."
23. MedPAC, Report to the Congress: Medicare Payment Policy.
24. CMS, "2009 Employer Group Waiver - Modification of the 2008 Service Area Extension Waiver Granted to Certain MA Local Coordinated Care Plans," 11 April 2008, http://www.cms.hhs.gov/EmpGrpWaivers/Downloads/2009-MA-Local-CCP- EG-Waiver-041108.pdf (accessed 3 July 2008).
25. The 2008 HMO data also include about 160,000 enrollees in state-based dual-eligible demonstrations recategorized by the CMS as HMO-based SNPs in that year.
26. We assumed that all enrollment was in the lowest-premium plan offered by the contract in that county; however, the unweighted data support similar conclusions.
27. We did not examine out-of-pocket spending for Part D because of data constraints and the complexity of such calculations.
28. Testimony of D.A. Lipschutz before the House Ways and Means Subcommittee on Health, "Medicare Advantage Costs, Benefits, and Oversight: The Beneficiary Experience" (Washington: U.S. House of Representatives, 28 February 2008);
29. and Medicare Rights Center, "Too Good to Be True: The Fine Print on Medicare Health Plan Benefits" (New York: Medicare Rights Center, April 2007).
30. Blum et al., "An Examination of Medicare Private Fee-for-Service Plans."
31. Congressional Budget Office, "Cost Estimate for HR 6331: July 23, 2008," http://www.cbo.gov/ftpdocs/95xx/doc9595/hr6331pgo.pdf (accessed 21 August 2008).
32. J. Verdier, M. Gold, and S. Davis, "Do We Know if Medicare Advantage Special Needs Plans Are Special?" (Washington: Kaiser Family Foundation, January 2008);
33. and C.J. Milligan and C.H. Woodcock, Medicare Advantage Special Needs Plans for Dual Eligibles: A Primer (New York: Commonwealth Fund, February 2008).
34. MedPAC, "Medicare Advantage Program Payment System - Payment Basics," in Medicare Payment Basics (Washington: MedPAC, October 2008).
35. J. Hoadley et al., "Medicare Prescription Drugs in 2008 and Key Changes since 2006: Summary of Findings" (Washington: Kaiser Family Foundation, April 2008).
36. P. Neuman et al., "Medicare Prescription Drug Benefit Progress Report: Findings from a 2006 National Survey of Seniors," Health Affairs 26, no. 5 (2007): w630-w643 (published online 21 August 2007; 10.1377/hlthaff.26.5.w630).
37. CMS support includes a beneficiary handbook, Web-based tools, toll-free telephone support, state-based assistance programs, and various outreach efforts. Regarding plan choice, see B. Elbel, "Is More Better? An Experimental Analysis of Plan Choice" (Presentation at the Academy Health 2008 Annual Research Meeting, Washington, D.C., 9 June 2008);
38. and J. Cubanski, "Medicare Drug Benefit Choices: Knowledge and Consumer Behavior among Medicare Beneficiaries" (Presentation at the Academy Health 2008 Annual Research Meeting, Washington, D.C., 9 June 2008).
39. MedPAC, Report to the Congress: Medicare Payment Policy; and CBO, "Medicare Advantage: Private Plans in Medicare," Issue Brief (Washington: CBO, June 2007).
40. MedPAC, Report to the Congress: Assessing Medicare Benefits (Washington: MedPAC, June 2002).
41. R.H. Miller and H.S. Luft, "HMO Plan Performance Update: An Analysis of the Literature, 1997-2001," Health Affairs 21, no. 4 (2002): 63-86.
42. MIPPA extends HEDIS reporting requirements to all MA plans, but putting this requirement into operation likely will be challenging.