Medicare Advantage

Medicare Part C refers to Medicare Advantage, where the federal government pays a fixed amount per member per month to private insurance companies that then coordinate and finance care

Consumers can select from a variety of private managed care plans and enroll in:

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Health maintenance organizations

Preferred provider insurance

Private fee for service plans

Special needs plans

Medicare Advantage has doubled its enrollments in the past decade

 

Complexity of Medicare Insurance-Part C: Medicare Advantage Coverage

Medicare’s Special Needs Program

Restricted to dual eligible Medicare/Medicaid insurance consumers residing in long term care facilities

Serves about 1.2 million consumers

 

 

Complexity of Medicare Insurance-Part C: Medicare Advantage Coverage

Administrative Complexity of Medicare Advantage

With private/public sector complexity, the federal government has no way to monitor access, use, or performance for the over 165 million consumers enrolled in Medicare Part C

Medicare Advantage insurance plans are not required to:

Have Medicare review of services

Negotiate fees

Report quality measures

The increase in competition generated by higher payments to Medicare Advantage has not translated into better benefits for consumers

 

Complexity of Medicare Insurance Part D: Medicare Prescription Drug Coverage

Medicare Part D prescription plans generally have at least two economic objectives:

(1)Allow the health care system to improve the overall delivery of health care to the Medicare-insured

(2)Relieve the financial burden on those who have trouble affording prescription drugs

 

 

 

 

While the prescription drug program has value, it does not begin to address either of these economic objectives:

It shows how public perceptions, or misconceptions, can unduly influence decisions about health risks

Example of health policy based not on a rational response to health risks, but rather on misperceptions of risks

 

 

Complexity of Medicare Insurance – Part D: Medicare Prescription Drug Coverage (1 of 2)

The drug plan, while providing coverage at the lower and upper ends of expenditures, allows for a coverage gap in the middle:

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