Medicare Advantage: Relationship Between Benefit Package Designs and Plans’ Average Beneficiary Health Status
DIANE Publishing, 2010 - 44 pages
Nearly 11 million Medicare beneficiaries are enrolled in Medicare Advantage (MA), Medicare's private health insur. option. Benefits vary by MA plan and may include coverage for services not avail. in traditional Medicare. To ensure MA plan benefit package designs do not discriminate against beneficiaries in poor health with high expected health care costs, the Centers for Medicare & Medicaid Serv. (CMS) reviews and approves all benefit packages yearly. This report examined: (1) MA plan benefit packages by average health status of plans' enrolled beneficiaries; (2) dist. and characteristics of MA plans by average beneficiary health status; and (3) CMS's process for ensuring that benefit packages do not discriminate with respect to health status. Charts and tables.
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2008 plan-level risk allowed to limit analysis of 2008 average health group average health status average indexed risk average plan beneficiaries in poor beneficiary health status categorized the health charge cost sharing chemotherapy drugs CMS risk score CMS thresholds CMS’s 2008 plan-level CMS’s Process coinsurance contract year 2010 copayment cost-sharing amounts cost-sharing reductions data by county enrolled beneficiaries GAO analysis group of plans health Average health higher cost sharing HMOs home health visits hospice care indexed risk score inpatient hospital stay inpatient mental health limit enrollment MAOs Medicaid Medicare & Medicaid Medicare Advantage Medicare FFS mental health stay OOP maximum payment benchmarks percent of plans Percentage of Beneficiaries plan benefit packages Plan Health Group plan-level risk score plan’s service area poor based poor health group potentially discriminatory preferred provider organization Quintile reduced renal dialysis risk score data Score and Health sharing that exceeded skilled nursing facility SNF stay targeted beneficiary population