Early Effects of the Medicare Modernization Act: Benefits, Cost Sharing, and Premiums of Medicare Advantage Plans, 2005 (original) (raw)
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This report from a series on benefits and premiums in Medicare+Choice plans updates existing analyses of trends from 1999 to reflect 2003 changes. It also looks at the scope of benefits available nationally, geographic variation, benefits and premiums in PPO demonstration plans, and the experience of Part B refund plans in their first year. Finds that monthly premiums in M+C continued to increase, though not as much as in 2002; the percent of enrollees with any prescription drug coverage declined slightly; and cost-sharing at point-of-service has increased steadily over the past three years.
In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the program, and monthly premiums and cost sharing rose in the remaining plans. In anticipation of an expanded role for private plans in 2006, the Medicare Modernization Act attempted to stabilize the program by authorizing additional payment increases for Medicare Advantage (formerly Medicare+Choice) plans in 2004, above what they were already slated to receive. This new paper profiles how Medicare payments to plans will change across the country, as well as the policy changes underlying the shift.
Medicare Advantage in 2006-2007: What Congress Intended? Health Affairs, Web Exclusive
2007
Starting in 2006, almost all Medicare beneficiaries have at least one Medicare Advantage (MA) plan available to them. Although new regional preferred provider organization (R-PPO) plans authorized through the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 contribute to this growth, private fee-for-service (PFFS) plans are more numerous and more popular with beneficiaries. Almost 1.5 million beneficiaries are in PFFS plans, 84 percent living in "floor" counties paid more by Medicare to encourage MA offerings. Whether beneficiaries are well served by policies that use scarce resources to encourage competition among largely unmanaged FFS plans is an issue that warrants discussion.
The role of private health plans in Medicare expanded substantially in 2004 under the Medicare Modernization Act, which builds on plan experience under Medicare+Choice, created in 1997 to offer more managed care choices for beneficiaries and recently renamed Medicare Advantage. Although sponsors originally hoped Medicare+Choice would lead to a greater role for private plans in Medicare, this report notes that the program is widely viewed as a failure, with plans leaving and beneficiaries having fewer, less attractive choices when the program ended in 2003 than they did when it began. As private plans continue to be a focal point for changing Medicare in the future, the researchers note that policymakers need a better understanding of the dynamics of the system to facilitate a successful transition in this latest effort.
Medicare Advantage: What Congress Intended? Orlando, FL: AcademyHealth Annual Research Meeting
2007
Changes in Medicare Advantage in the MMA reversed the prior erosion in private plan availability and enrollment under Medicare+Choice. Shift began before 2006 (Part D benefit and changes) but intensified thereafter Changes in Medicare Advantage in the MMA reversed the prior erosion in private plan availability and enrollment under Medicare+Choice. Shift began before 2006 (Part D benefit and changes) but intensified thereafter 2 Overview of Findings -II Overview of Findings -II PFFS accounts disproportionately for growth in MA availability and enrollment across the country. As a replacement supplement, PFFS provides attractive premiums with the promise of open access. But financial and access risk in PFFS typically is higher than in Medigap and perhaps higher than beneficiaries expect. PFFS accounts disproportionately for growth in MA availability and enrollment across the country.