TITLE

Medicare+Choice: Reforms Have Reduced, but Likely Not Eliminated, Excess Plan Payments: HEHS-99-144

PUB. DATE

June 1999

SOURCE

GAO Reports;6/18/1999, p1

SOURCE TYPE

Government Document

DOC. TYPE

Article

ABSTRACT

The Medicare+Choice program was created in 1997 to expand beneficiaries' health plan options, both by encouraging the wider availability of health maintenance organizations and by permitting other types of health plans, such as preferred provider organizations, to participate in Medicare. At the same time, the methodology used to determine plan payments was changed, in part because of concerns that (1) many health plans were overcompensated for the beneficiaries they served and (2) Medicare's managed care program had not, as originally expected, saved the program money. The new methodology is designed to both slow the growth of aggregate payments and more closely align per capita payments with the expected health care costs of plan members. Some health plan and industry representatives believe that these payment changes were too severe and will reduce beneficiaries' access to plans and additional benefits, such as outpatient prescription drug coverage, that are unavailable under fee-for-service plans. This report (1) reviews the extent to which health plans now provide additional benefits and whether they could continue to provide additional benefits if payments were reduced, (2) summarizes the evidence about managed care's effect on Medicare spending, and (3) assesses whether the provisions of the Balanced Budget Act will eliminate excess plan payments.

ACCESSION #

18227496

Tags: MEDICARE;  HEALTH insurance -- United States;  HEALTH insurance;  OLDER people -- Medical care -- United States;  MEDICAL policy;  MEDICAL care costs

 

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