The policy community generally has assumed Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. After surveying senior hospital and health plan executives, we found, however, that MA plans nominally pay only 100-105 percent of traditional Medicare rates and, in real economic terms, possibly less. Respondents broadly identified three primary reasons for near-payment equivalence: statutory and regulatory provisions that limit out-of-network payments to traditional Medicare rates, de facto budget constraints that MA plans face because of the need to compete with traditional Medicare and other MA plans, and a market equilibrium that permits relatively lower MA rates as long as commercial rates remain well above the traditional Medicare rates. We explored a number of policy implications not only for the MA program but also for the problem of high and variable hospital prices in commercial insurance markets.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1377/hlthaff.2014.1427 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The Effect of Extending the Window to Disenroll From Medicare Advantage Among Post-Acute Users.
Med Care Res Rev
January 2025
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
Post-acute care users in Medicare Advantage (MA) plans may seek coverage changes if facing issues with plan benefits. In 2019, the Centers for Medicare and Medicaid Services extended the deadline to disenroll from an MA plan from February 14 to March 31 and, for the first time, permitted beneficiaries to switch to a different MA plan instead of traditional Medicare. Using 2016-2019 Medicare administrative data, we implemented a difference-in-differences approach to evaluate the impact of this policy on disenrollment from a plan within 1 month of initiating skilled nursing facility or home health services.
View Article and Find Full Text PDFEstimating financial and health burden by initial Medicare plan choice and history of cancer.
Health Aff Sch
January 2025
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN 37203, United States.
Understanding the downstream consequences of initial Medicare plan selection is necessary to ensure access to and affordability of health care services, especially for older adults with serious illness. We used 2008-2020 data from the Health and Retirement Study to estimate financial and health burden by initial Medicare plan selection (traditional Medicare without supplemental coverage, traditional Medicare plus supplemental coverage, or Medicare Advantage) and self-reported history of cancer. Initially choosing benefits with greater financial protections (either traditional Medicare plus supplemental coverage or Medicare Advantage) relative to traditional Medicare without supplemental coverage was associated with lower levels of out-of-pocket spending and a lower likelihood of reporting cost-related medication nonadherence and fair or poor health.
View Article and Find Full Text PDFNational Trends in Stroke Presentation, Treatments, and Outcomes During the First 2 Years of the COVID-19 Pandemic.
Neurol Clin Pract
April 2025
Department of Health Care Policy, Harvard Medical School, Boston, MA.
Background And Objectives: Early presentation and acute treatment for patients presenting with ischemic stroke are associated with improved outcomes. The onset of the COVID-19 pandemic was associated with a large decrease in patients presenting with ischemic stroke, but it is unknown whether these changes persisted.
Methods: This study analyzed emergency department (ED) stroke presentations (n = 158,060) to all nonfederal hospitals in the 50 states and Washington, D.
Association of Mobile Stroke Unit Care and Spending, Utilization, and Death in New York City.
J Am Heart Assoc
January 2025
Department of Population Health Sciences Weill Cornell Medicine New York NY.
Background: Transport by mobile stroke units (MSUs), which provide access to computed tomography scanning and intravenous blood pressure medications and thrombolytics, reduces time to treatment and may improve short-term functional outcomes for patients with acute stroke. The longer-term clinical and financial impacts remain incompletely understood. The aim of the study was to determine whether MSU care is associated with better health, utilization, and spending outcomes for patients with suspected acute stroke.
View Article and Find Full Text PDFOut-Of-Network Utilization and Plan Selection Among Medicare Advantage Cost Plan Enrollees.
Health Serv Res
January 2025
Schaeffer Center for Health Policy & Economics, Price School of Public Policy, University of Southern California, Los Angeles, California, USA.
Objective: To understand how Medicare Advantage (MA) networks impact utilization patterns and plan choices, using the 2019 discontinuation of MA 1876 Cost plans as a natural experiment.
Study Setting And Design: We study 1876 Cost plans, MA plans for which out-of-network care is covered through traditional Medicare (TM) and many of which CMS discontinued in 2019. We characterize the proportion of Cost plan enrollees who utilized out-of-network care in 2018 from different types of medical specialties.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!