Medicare: Medicare Advantage
From Families USA:
Emphasizing Preventive Care and Wellness in Medicare
This series of fact sheets discusses how Medicare is taking an important step forward, thanks to the Affordable Care Act, to provide more preventive and wellness care to beneficiaries. Medicare is now providing free preventive care and a free annual wellness visit that will help beneficiaries prevent illness in the first place. These fact sheets discuss how beneficiaries can take advantage of these benefits and how advocates can answer questions and resolve problems. (March 2011)
For consumers:
For advocates:
Lower Costs, Better Care: Medicare Cost Savings in the Affordable Care Act discusses how the Affordable Care Act will make Medicare work more efficiently by improving the way providers deliver care, modernizing how Medicare pays for services, and eliminating waste, fraud, and abuse in the system. These changes will also reduce costs, make the program more sustainable, and allow for better benefits for those who depend on Medicare. | Talking Points (September 2010)
Helping People with Medicare discusses how health reform will help make Medicare more affordable for seniors and people with disabilities, improve health care quality for enrollees, and make the program more financially secure. (June 2010)
A Summary of the New Health Reform Law describes the major changes in health coverage that health reform will bring, including Medicaid and CHIP coverage, the affordability provisions, the exchanges, individual and employer responsibility requirements, improvements in private market coverage, and changes to Medicare and long-term services. (April 2010)
Medicare Advantage: Senate Bill Makes Necessary Changes discusses several long-overdue changes that the Senate health reform bill would make, including rolling back the billions of dollars in overpayments that go to these plans. (December 2009)
Help for People with Medicare discusses how the health reform legislation that is before Congress will help make Medicare more affordable for seniors and people with disabilities, as well as help make the program more financially secure. (August 2009)
Congress Delivers Help to People with Medicare: An Overview of the Medicare Improvements for Patients and Providers Act discusses the positive changes the Medicare Improvements for Patients and Providers Act (MIPPA) makes to Medicare. These changes include the improvement of Medicare health care benefits, the creation of policies that reduce racial and ethnic disparities among beneficiaries, and the reining in of inefficient private Medicare Advantage Plans. (October 2008)
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 for American Progress:
Medicare Doesn’t Work As Well for Younger, Disabled Beneficiaries As It Does for Older Enrollees found that nonelderly (under age 65) beneficiaries experience more problems with cost and access, including greater difficulty affording medications. The Affordable Care Act includes reforms that could remedy the problem by improving access to care and limiting out-of-pocket costs for this group. (August 2010) Subscription Required
Adding Up the Numbers: Understanding Medicare Savings in the Affordable Care Act looks at how the Medicare savings that will be achieved under the new law will significantly improve the fiscal stability of the program, and, in turn, improve the efficiency and quality of the health care system overall. (September 2010)
From the Center on Budget and Policy Priorities:
Health Reform Changes to Medicare Advantage Strengthen Medicare and Protect Beneficiaries discusses how the new law will affect people enrolled in Medicare Advantage plans, including provisions that became controversial during the debate. Contrary to the law’s critics, the changes in overpayments to private plans do not take effect until 2012, and all guaranteed Medicare benefits will continue to be covered. (July 2010)
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 in the Era of Health Reform: Progress in Leveling the Playing Field looks at payment levels in the Medicare Advantage program for 2010, taking into account the different factors that affect payment levels and variations in payment levels across states and counties. The health reform law gradually lowers Medicare Advantage overpayments, bringing their payments more in line with traditional Medicare. (March 2011)
Paying Medicare Advantage Plans by Competitive Bidding: How Much Competition Is There? details how private insurance companies that sell Medicare Advantage (MA) plans receive 13 percent more than traditional Medicare and examines reform proposals that recommend replacing overpayments with a system of competitive bidding. Often, a small number of insurance companies dominate the MA market, meaning that a system of competitive bidding could still be highly influenced by the bids of a few companies, limiting true competition. (August 2009)
The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009 concludes that payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee. If these beneficiaries were enrolled in traditional Medicare instead, more than $150 billion could be saved over 10 years, which could be used to finance improved benefits for the low-income elderly and disabled or for expanding health coverage. (May 2009)
Medicare Advantage’s Private Fee-For-Service Plans: Paying for Coordinated Care without the Coordination examines the policies underlying the rapid increase in these plans and in their enrollment, the payments they receive, and the potential impact of recent Medicare legislation (MIPPA). Payments to PFFS plans in 2008 averaged 16.6 percent more than those for traditional fee-for-service Medicare. PFFS plans have concentrated their focus on counties with especially high levels of extra payments, resulting in an unequal geographic distribution of PFFS plan enrollment, with the majority centered in urban areas. (October 2008)
The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans in 2008 considers the policies of the Medicare Modernization Act (MMA) that have spurred greater enrollment in private plans and that have substantially increased Medicare costs. Private health plans serving Medicare beneficiaries will be paid an average of 12.4 percent more per enrollee in 2008 compared to what the same enrollee would have cost in the traditional Medicare fee-for-service program. (September 2008)
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 the George Washington University School of Public Health and Health Services:
Medicare Advantage Payment Provisions: Health Care and Education Affordability Reconciliation Act of 2010 H.R. 4872 provides an overview of the new payment policy and analyzes data from 2009 to estimate the impact it will have on payments to Medicare Advantage plans. The report estimates that the overall impact will be modest. (March 2010)
From the Government Accountability Office:
Medicare Advantage: Characteristics, Financial Risks, and Disenrollment Rates of Beneficiaries in Private Fee-for-Service Plans reports that the administrative practices used by private fee-for-service (PFFS) plans can lead to higher costs for Medicare beneficiaries than in traditional fee-for-service plans. In addition, between January and April 2007, beneficiaries in PFFS plans disenrolled at an average rate of 21 percent, compared to 9 percent for other MA plans. The study also found that CMS has not complied with statutory requirements to mail Medicare beneficiaries disenrollment rates for MA plans in their areas. (December 2008)
Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2005 reports that Medicare Advantage plans, on average, projected spending 90.2 percent of total revenue on medical services but actually spent 85.7 percent. This resulted in an extra $1.14 billion in profits in 2005. (June 2008)
From Health Affairs:
Complex Medicare Advantage Choices May Overwhelm Seniors—Especially Those with Impaired Decision Making explains that simplifying choices in Medicare Advantage could improve beneficiaries’ enrollment decisions, strengthen value-based competition among plans, extend the benefits of choice to seniors with impaired cognition, and lower out-of-pocket costs for enrollees. Subscription required. (September 2011)
Medicare Advantage Plans discusses the history of Medicare Advantage plans, changes that were mandated by the health care law, and issues that may emerge from ongoing legislative and legal challenges. (June 2011)
Medicare’s Private Plans: A Report Card on Medicare Advantage reports that private Medicare Advantage plans are increasing costs for Medicare but not necessarily improving care. Though the Medicare Modernization Act (MMA) has expanded beneficiaries’ choice of plans, it has added to Medicare’s complexity and created potential inequities. A stronger system of performance monitoring and accountability is needed to meet Medicare’s fiduciary requirements and oversight responsibilities. SUBSCRIPTION REQUIRED. (November 2008)
Payment Policy and the Growth of Medicare Advantage reviews recent trends in Medicare Advantage, examining program costs, access to plans, enrollment, plan bids, and benchmarks. These plans are paid, on average, 113 percent of what expenditures would have been under traditional Medicare. Although some of these plan payments are used to finance extra benefits for enrollees, paying plans at higher than fee-for-service levels could affect the sustainability of the Medicare program and result in increased costs for taxpayers and beneficiaries. SUBSCRIPTION REQUIRED. (November 2008)
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:
Medicare Advantage 2013 Spotlight: Plan Availability and Premiums examines trends in the Medicare Advantage market, including the options available and premium levels. It finds that almost all of the plans that were available this year will be offered again in 2013, and premiums for beneficiaries who stay in their current plans will increase by 10 percent (on average). (December 2012)
Medicare Advantage Plan Star Ratings and Bonus Payments in 2012 discusses the scaled bonus payments that will be added to the existing five-star rating system. To encourage improvements in health care quality, plans will be awarded a bonus if they receive a rating of three stars or higher. (November 2011)
Medicare Advantage 2011 Data Spotlight: Medicare Advantage Enrollment Market Update examines trends to find that, despite concerns about the possible effects of the reduction in overpayments that were required by the health reform law, enrollment continued to rise this year, and enrollees are paying lower premiums than they did in 2010. (September 2011)
Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums reviews recent changes to the program and examines trends in plan participation, premiums, and certain benefits, including prescription drug coverage. The analysis shows that the market will experience modest changes next year, but individual enrollees’ experiences will vary by county and across plans. (October 2010)
Medicare Advantage 2010 Data Spotlight: Plan Enrollment Patterns and Trends finds that a small number of firms dominate enrollment, both nationally and in most states. While health reform is expected to affect plan participation, enrollment, premiums, and extra benefits, these plans will continue to be an important option for many beneficiaries. (June 2010)
Explaining Health Reform: Key Changes in the Medicare Advantage Program looks at how health reform will affect seniors in Medicare Advantage plans. The new law eliminates overpayments to Medicare Advantage plans, rewards high-quality plans, and strengthens consumer protections for enrollees. (May 2010)
Medicare Advantage 2010 Data Spotlight: Benefits and Cost-Sharing examines out-of-pocket spending limits and cost-sharing for a variety of different benefits, including primary care, preventive care, drug coverage, and benefits that are not covered under Medicare, compared to traditional Medicare. While many Medicare Advantage plans offer lower premiums, cost-sharing is often higher than in traditional Medicare. (February 2010)
Medicare Advantage 2010 Data Spotlight: Plan Availability and Premiums discusses information recently released by the Centers for Medicare and Medicaid Services (CMS) about Medicare Advantage Plans that will be available in 2010. The brief looks at plan options, availability, and premiums, and it highlights important changes between 2009 and 2010. (November 2009)
Strategies for Simplifying the Medicare Advantage Market argues that fewer plan offerings, or more transparent differences across plans, would help beneficiaries choose the plans that are most likely to meet their individual needs. Research shows that individuals faced with a large number of alternatives often avoid making a decision, or they choose options that may not be best for them economically. This report outlines nine ways to simplify the process of choosing a plan. (July 2009)
The Medicare Health and Prescription Drug Plan Tracker is an updated, interactive, online resource with new 2009 data about Medicare Advantage and Medicare prescription drug plans, as well as 2008 enrollment data. It provides information on stand-alone prescription drug plans nationally and by state, and on Medicare Advantage plans by region and county. The resource can be used to monitor trends in Medicare Advantage plans since 1999 and in Part D plans since their inception in 2006. (November 2008)
Examining Sources of Coverage among Medicare Beneficiaries: Supplemental Insurance, Medicare Advantage, and Prescription Drug Coverage -- Findings from the Medicare Current Beneficiary Survey, 2006 provides the first detailed look at the characteristics of beneficiaries with various sources of drug coverage in the first year of the Medicare Part D drug benefit. The chart pack compares the characteristics of Medicare beneficiaries enrolled in Medicare Advantage plans to beneficiaries in traditional fee-for-service Medicare. It also examines drug coverage and enrollment in the low-income subsidy among beneficiaries with low incomes. (August 2008)
Medicare Advantage in 2008 analyzes recent developments in the Medicare Advantage (MA) marketplace, including the plan choices that are available to beneficiaries and enrollment trends by plan type and geography. The brief also examines market share for the companies that offer MA plans and the role that MA plans play in providing employer-sponsored retiree health benefits. (June 2008)
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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