The Affordable Care Act has altered payment policy for private Medicare Advantage (MA) plans, with the goal of lowering costs closer to the level in traditional Medicare. Using newly available information on 2009 MA plan costs, this analysis com­pares plans' estimates of per capita costs for providing Parts A and B benefits to their enrollees, on a risk-adjusted basis, against what government d...

The effectiveness of proposed changes to the Medicare program depends on consumers' responses to different market incentives, which vary according to the coverage the elderly possess to supplement their Medicare coverage. This Data Watch explores the extent of supplemental insurance among the elderly, based on a new data set from the Medicare Current Beneficiary Survey. Only 11 percent of Medic...

Medicare costs are rising faster than projected revenues. Action to close the emerging deficit is inescapable. We propose converting Medicare from a "service reimbursement" system to a "premium support" system. These changes would resemble many that are now reshaping private employer-based insurance. Our reform would encompass not just the "public" Medicare program but also the "real" Medicare,...

Zirui Song, PhD David M. Cutler, PhD Michael E. Chernew, PhD THE IDEA OF A PREMIUM SUPPORT (OR VOUCHER) SYStem for Medicare has generated substantial debate. Under premium support, Medicare beneficiaries would choose from health plans that compete in a market-based bidding system. In some models, traditional Medicare is abandoned entirely in favor of private health plans. In other models such a...

When Medicare was first implemented in 1966 nearly half of all Americans 65 and older were without health insurance. Fifty years later only 2% lack health insurance. The difference, of course, is Medicare. Medicare now covers 55 million people, about 17% of the U.S. population, and is the single largest purchaser of personal health care. But despite this success the rising costs of health care ...

OBJECTIVE To analyze variability in urologists' Medicare utilization and payment and estimate potential cost savings of standardized service utilization using information from the recently released Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF) and to highlight potential limitations of PUF analysis. MATERIALS AND METHODS The Centers for Medi...

OBJECTIVES To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans. DESIGN Retrospective cohort study. SETTING Data from the Health and Retirement Study linked to Medicare claims. PARTICI...

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...

This article identifies factors that influence health maintenance organizations' (HMOs) decisions about offering a Medicare risk product in rural areas; describes HMOs' recent experiences serving rural Medicare risk enrollees; and assesses the potential impact of Medicare program changes on the future willingness of HMOs to offer a Medicare risk product in rural areas. Data for the analysis wer...

This study estimates that Medicare extra payments under the hospital prospective payment system (PPS) range from about $700 per case of decubitus ulcer to $9,000 per case of postoperative sepsis in the five types of adverse events identifiable in Medicare claims. Medicare extra payment for the five types of events totals more than $300 million per year, accounting for 0.27 percent of annual Med...