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PubMed1981

Medicare program; Medigap--certification of Medicare supplemental health insurance policies: Health Care Financing Administration. Proposed rule.

This proposal would establish a program of certification, by the Secretary, of Medicare supplemental health insurance policies (so-called Medigap policies) voluntarily submitted by insurers for review. It would implement, in part, section 507 of the Social Security Disability Amendments of 1980. HCFA will administer the certification program. The voluntary certification program would go into effect July 1, 1982, and would apply only to policies issued in those States that do not have in effect a program for regulating Medigap policies equal to or more stringent than the one to be described in these regulations. A Supplemental Health Insurance Panel, consisting of the Secretary or a designee and four State Commissioners of Superintendents of Insurance appointed by the President, will determine the adequacy of a State's program in relation to the standards contained in the regulations. These regulations would: (1) set standards for policies voluntarily submitted to HCFA for certification, (2) establish procedures for the certification program, and (3) promulgate the statutory requirements that the Supplemental Health Insurance Panel would use to approve State regulatory programs.

Certification↗
PubMed2002

Medigap: prevalence, premiums, and opportunities for reform.

This issue brief provides an overview of Medicare's coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the entire Medicare program.

Cost Sharing↗
PubMed2003

Medigap reform legislation of 1990: a 10-year review.

The 1990 Medigap reform legislation sought to make it easier for consumers to compare policies, provide market stability, promote competition, and avoid adverse selection. Evidence is that the standardization of benefits has simplified consumer choice and is strongly supported by consumers and State regulators. The 1990 reforms also decreased carrier and agent abuses. However, loss ratios (the proportion of premiums paid in benefits versus being retained for administration and profit) have changed little since 1990, bringing into question whether price competition has been enhanced. The prescription drug benefit, which is included in 3 of the 10 standardized plans, provides only limited financial protection yet is expensive, one reason being adverse selection. Access to coverage for Medicare disabled beneficiaries is problematic in most States.

Aged↗
PubMed2001

Medicare beneficiaries' management of capped prescription benefits.

BACKGROUND: Having annual dollar limits in prescription coverage is a type of benefit design unique to Medicare beneficiaries. This type of coverage is found predominantly within private Medigap policies and Medicare+Choice plans offering prescription coverage. OBJECTIVES: The purpose of this study was to determine the impact of capped prescription benefits on efforts to reduce out-of-pocket prescription expenses by beneficiaries at risk for reaching their cap. RESEARCH DESIGN: This design was quasi-experimental, with data obtained from self-administered questionnaires mailed to 600 Medicare HMO risk enrollees with capped prescription benefits. RESULTS: Data were collected on 378 Medicare enrollees for a 63% response rate. Approximately half of all respondents participated in > or =1 strategy to reduce their out-of-pocket prescription expenses. Participation in selected strategies included obtaining samples from physicians (39.2%), taking less than prescribed amounts (23.6%), and discontinuing prescribed medications (16.3%). Additionally, 15% of respondents indicated going without necessities, and 12% indicated borrowing money to pay for their prescriptions. Those who reached their prescription cap were more likely to participant in any one behavior (odds ratio [OR], 2.18), more likely to take less medication than prescribed (OR, 2.83), more likely to discontinue a medication (OR, 3.36), and more likely to obtain samples from their physician (OR, 2.02) compared with those who had not reached their prescription cap. CONCLUSIONS: Beneficiaries at risk for reaching their prescription cap are taking steps to reduce their out-of-pocket prescription costs. Although some behaviors would be considered prudent, other behaviors may be placing beneficiaries at risk for drug-related morbidity and mortality.

Aged↗
PubMed1988

Financing long-term care. Health and Public Policy Committee. American College of Physicians.

The availability and delivery of long-term care services in the United States have been hindered by major organizational and financial problems. The American College of Physicians has previously identified and addressed some of the organizational problems that impede access to long-term care. In this issues paper, we provide background information on and analysis of the costs and the methods currently used to finance such care in the United States. The Canadian National Health Care System is also described for comparison. We then analyze such alternative financing mechanisms as private individual insurance (beyond Medigap), employment-based long-term care insurance, self-insurance, vouchers, financing through Medicare, home equity conversions, and prepaid capitated case management plans. The advantages and disadvantages of each of these methods are presented.

Aged↗
PubMed1993

Retiree health benefits.

Some 80% of elderly Medicare beneficiaries have private supplemental insurance. Approximately 50% of these have some form of medigap of privately purchased coverage. Those holding private coverage tend to be younger, more highly educated, and white. Women are more likely to hold medigap type plans, and men are more likely to have employment related coverage. The extent of multiple coverage is relatively rare. One estimate puts multiple coverage at about 20% of those with private supplemental coverage. Contrary to conventional wisdom, those with multiple coverage are not the very old and poorly educated. Rather, they tend to be younger and more highly educated. Also, women are more likely to have both employer-sponsored and medigap coverage, maybe because of the uncertainty about whether a wife will continue to have employer-sponsored post-retirement coverage after her husband has died. Medigap-type health insurance is heavy on first dollar coverage; the Medicare deductibles and copayments are covered. Provisions of OBRA 1990 will homogenize this coverage even more. Employer-sponsored health benefits are common. Some 8.4 million elderly Medicare beneficiaries have employer-sponsored coverage. A large but undetermined number of early retirees also have coverage. These recipients have generally been the workers in very large firms. However, the future will not look like the past. Two thirds of current workers are promised health benefits upon retirement. The benefits provided under these plans are both broad and deep. The nature of benefit coordination between these plans and Medicare can reduce the size of the apparent benefits. The carve-out method of coordination is the most common and can result in sizable out-of-pocket payments by the beneficiary. However, it is not obvious that employer-sponsored plans have been designed to exploit this opportunity. There is little information on the conditions under which a worker is vested for health benefits. The sketchy evidence that does exist suggests that a worker must retire from the firm and have had time in service about equal to that required for the firm's pension plan. Firms apparently can change their retiree benefit plans if they have explicitly retained the right to do so. There are sound economic reasons to suggest that many firms would honor their commitments, even in the absence of legal requirements. Supplemental retiree coverage leads to additional use of health services, particularly by those in poorer health and particularly by those with plans that feature first-dollar coverage. The increased use of services as a result of supplemental coverage also increases Medicare's costs.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMedDate not supplied

Toward better access to health insurance coverage for U.S. retirees in Mexico.

Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare) is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of living. The numbers are increasing as a result of several factors such as aging "baby boomers" and the rapidly growing Mexican-origin population in the U.S.A. who are citizens or permanent residents but would like to return to their communities of origin after working in the U.S.A. There are several policy initiatives that could provide opportunities for improving health insurance coverage for these retirees that could be cost-effective.

Health Services Accessibility↗
PubMed1992

Policy reform as creative destruction: political and administrative challenges in preserving the public-private mix.

As political pressure for affordable universal coverage intensifies, various proposals have been crafted to improve the system without sacrificing the role of the private sector. Some analysts view the preservation of a mixed public-private system as an exercise in incrementalism, avoiding disquieting departures from familiar arrangements. A review of the political and administrative challenges of several main options--market innovation, tax credits, play or pay, and Medicaid expansion--suggests that the path to true reform is a slippery slope. Over time, changes in particular sectors, such as insurance, employers, government, and providers, will very likely implicate the others too. Although redefining the public-private mix may be more incremental than (say) adoption of a Canadian model, it will also entail considerable "creative destruction" of existing patterns and cannot fail to disturb the institutional status quo substantially.

Financing, Government↗
PubMed2004

Does open enrollment control premiums? A case study from the "Medigap" market.

This article analyzes a change in "Medigap" regulations that occurred in Missouri in 1999. It allows Medicare beneficiaries in the state to switch to a different carrier each year so long as they retain the same standardized policy type, without losing their open enrollment privileges. The analysis is based on a comparison of various outcomes in Missouri and those in two comparison states, Kansas and Florida. We found little evidence that the policy change affected premiums charged by insurance carriers in Missouri, but conclude that other desirable aspects of the change make it potentially attractive for other states to follow.

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