We conducted a descriptive study examining the health status of dually eligible beneficiaries using a sample from the Medicare Health Outcomes Survey (HOS), a measure of health status administered to enrollees in Medicare managed care (MMC). Overall, we found that dually eligible beneficiaries were sicker, more depressed, and reporting more pain than Medicare-only beneficiaries. Our results sug...

The Medicare Payment Advisory Commission (MedPAC) has identified two important problems with the Medicare+Choice (M+C) program: nationwide geographic inequity in government-financed benefits, and unequal government payments for M+C plans versus fee-for-service (FFS) Medicare in the same market area. MedPAC concludes that both problems cannot be solved simultaneously. We argue that both problems...

This study focused on persons 65 years of age and over who were dually entitled to Medicare and Medicaid in 1978. The paper examines their age, sex, and race characteristics, and their Medicare utilization and mortality rates in comparison to persons eligible for Medicare only. The study showed that the group entitled to both Medicare and Medicaid was relatively much older than those with Medic...

INTRODUCTION The increase in chronic health conditions among Medicare beneficiaries has implications for the Medicare system. The objective of this study was to use the US Department of Health and Human Services Strategic Framework on multiple chronic conditions as a basis to examine the prevalence of multiple chronic conditions among Medicare beneficiaries. ANALYSIS We analyzed Centers for M...

PURPOSE Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. DESIGN AND METHODS An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 resident...

INTRODUCTION Medicare beneficiaries who have chronic conditions are responsible for a disproportionate share of Medicare fee-for-service expenditures. The objective of this study was to analyze the change in the health of Medicare beneficiaries enrolled in Part A (hospital insurance) between 2008 and 2010 by comparing the prevalence of 11 chronic conditions. METHODS We conducted descriptive a...

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial imp...

In late June of last year, both the House and the Senate passed the most meaningful Medicare reform legislation since Medicare’s inception in 1965. As luck would have it, this occurred just days before I joined Centers for Medicare and Medicaid Services (CMS) as a Health Policy Scholar. This role provided me not only a front row seat, but a place on the playing field as CMS works to operational...

BACKGROUND Medicare Part D and the U.S. Department of Veterans Affairs (VA) use different approaches to manage prescription drug benefits, with implications for spending. Medicare relies on private plans with distinct formularies, whereas the VA administers its own benefit using a national formulary. OBJECTIVE To compare overall and regional rates of brand-name drug use among older adults wit...

BACKGROUND Breast cancer is a leading cause of mortality for women in all racial/ethnic groups. We compared use of mammography by race/ethnicity in Medicare health maintenance organizations (HMOs), preferred provider organizations (PPOs), and traditional Medicare. METHODS We matched 495 836 women in HMOs and 81 480 women in PPOs who were aged 65 to 69 years during 2009 to women enrolled in tr...