Commonwealth Fund researchers said Medicare Advantage plans will need enhanced incentives to make sure that high-quality care is provided at lower cost, as the number of beneficiaries in these plans is expected to climb by 2027.
In a new Commonwealth Fund research report, researchers said Medicare Advantage plans will need enhanced incentives to make sure that high-quality care is provided at lower cost.
Enrollment in Medicare Advantage plans has increased more than 80% since 2009, and today, 33% of Medicare beneficiaries are in these private plans. Average plan premiums have fallen since 2010, and payments have decreased relative to traditional Medicare.
These risk-based private insurance plans (sometimes called Part C plans) began with goals of improving care quality, controlling spending, and providing additional benefits to beneficiaries than offered by traditional Medicare. Under a monthly, capitated sum, the plans assume liability for a beneficiary’s health expenses.
While some goals have been achieved, in many parts of the country, the plans are paid more than traditional Medicare would be expected to spend for the same beneficiaries.
Commonwealth researchers examined major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost sharing, total costs to Medicare, and quality of care.
The report, called the Evolution of Private Plans in Medicare, traces these time periods and the policy developments that happened within those timeframes:
With the Congressional Budget Office projecting that 41% of beneficiaries will be enrolled in Medicare Advantage by 2027, the report made these conclusions:
The Supreme Court seems likely to reject a challenge to the abortion pill mifepristone; the FDA is inspecting far fewer pharmaceutical companies conducting clinical research; AstraZeneca has sued to block an Arkansas law that it said would unlawfully expand the 340B program to include for profit-pharmacy chains.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Covered Preventive Services at Risk: V-BID Summit Breaks Down the Braidwood v Becerra Case
March 20th 2024For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Most private health insurers have yet to publish criteria for when they will cover postpartum depression drug, zuranolone; state lawmakers are increasingly opposing health care mergers that they believe do not serve the public interest; Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance.
Read More
President Biden will preview his plan to more than double the size of Medicare’s new drug price negotiation program in the upcoming State of the Union address; Mexicans and Central Americans were most affected by the pandemic in terms of all-cause mortality; two Alabama fertility clinics said they expect to resume in vitro fertilization (IVF) services after a bill was passed to protect doctors.
Read More