The creators of the Medicare Advantage (MA) program envisioned that seniors would opt out of fee-for-service Medicare to take advantage of the lower premiums, lower cost-sharing, and additional benefits available in private plans. Earlier research, however, indicates that out-of-pocket costs for MA enrollees vary widely by health status and plan benefit package. This issue brief examines out-of...

Under the new Medicare drug benefit, beneficiaries residing in nursing homes and other long-term care (LTC) facilities have the same wide selection of Part D prescription drug plans available to community-dwelling beneficiaries. However, Part D does not alter Part A coverage for drugs during qualified skilled nursing facility (SNF) stays. This raises questions of whether drug utilization patter...

An earlier study of Federal civil-service annuitants.’ based on a IO-percent sample. showed that more than 4 out of 10 of the nearly 1 million annuitants on the rolls in December 1975 were alsn receiving cash benefits under the old-age, survivors, disability, and health insurance (OASDHI) program. Most of these “dual beneficiaries” were “primary beneficiaries”-that is. they were entitled to soc...

The Medicare drug benefit (Medicare "Part D"), provides federal subsidies to pay premiums and cost sharing for low-income beneficiaries--almost 10 million in 2009. Yet there are several policy issues concerning these low-income beneficiaries under Part D. First, over 2 million individuals who may qualify for the subsidies have not enrolled. Second, in some states, low-income beneficiaries have ...

Medicare Part D became available in 2006, offering millions of Americans the potential for improved access to medications. Certain aspects of the program have been problematic or confusing for vulnerable beneficiaries, but creative efforts across the country have helped individuals obtain and use the Part D benefit. Coalitions supply the information, training, and support that community partner...

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expands the role of private health plans in Medicare through prescription drug plans and a revised Medicare+Choice (M+C), renamed Medicare Advantage, program. This paper discusses the factors responsible for the failure of M+C to develop as intended in 1997 and analyzes the challenges for MMA implementation in ligh...

There is concern about the adequacy of diagnosis-based risk adjusters for paying health plans that disproportionately enroll frail Medicare beneficiaries. The Medicare Current Beneficiary Survey (MCBS) was used to examine the ability of two risk-adjustment models to predict Medicare costs for groups defined by institutional status and difficulty with activities of daily living (ADLs). Both mode...

A summary of findings from the Evaluation of the Medicare Competition Demonstrations is presented in this article. The purpose of this evaluation was to examine the implementation and operational experiences of the 26 health maintenance organizations that operated as demonstrations from 1983 to 1985, their experiences in marketing their plans, the factors that affected beneficiaries' decisions ...

In 1995, combined Medicare and Medicaid spending in the last year of life for dually eligible beneficiaries was more than $40,000 per beneficiary. Medicaid's share, primarily for long-term care (LTC), constituted about 40 percent of the total. Beneficiaries under age 65, Black persons, and individuals who died in a hospital had higher than average expenditures. The vast majority (86 percent) re...

In this article, data are presented on trends in the use of and program payments for inpatient short-stay hospital services to Medicare beneficiaries. The data on the services used by aged and disabled Medicare beneficiaries are presented for the years 1972 through 1988. The discussion is focused on trends in utilization and program payments resulting from the implementation of the Medicare pro...