The future of Medicare supplement products ... or is there one?
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Insurance, Medigap↗
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Medicare seniors much less willing to limit physician-hospital choice for lower costs.
Elderly Americans are much less willing than working-age Americans to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, according to a new national study by the Center for Studying Health System Change (HSC). Only 44 percent of seniors 65 and older were willing to trade broad provider choice to save money, compared with more than 70 percent of people aged 18 through 34. Among seniors, those enrolled in Medicare health maintenance organizations (HMOs) were the most willing to limit choice of providers in return for lower out-of-pocket costs, while Medicare seniors with supplemental coverage were the least willing. Seniors with supplemental coverage account for nearly six in 10 Medicare seniors, and with nearly two-thirds of these seniors opposing provider choice restrictions, policy makers seeking to expand enrollment in Medicare Advantage managed care plans may face challenges.
Age Factors↗
New dimensions of economic well-being among people with mental illness: evidence from Healthcare for Communities.
OBJECTIVE: To analyze the relationship between mental health and savings and compare it to the relationship between common chronic physical conditions and savings. DATA SOURCE: Healthcare for Communities, a national survey conducted in 1997/1998 with approximately 10,000 respondents. STUDY DESIGN: We used logistic regression to analyze any savings versus no savings and used ordinary least squares regression to study level of savings conditional on having any savings. PRINCIPAL FINDINGS: Individuals screening positive for any mental health disorder are less than two-thirds as likely as individuals with no mental health problems to have any savings. The percent age of savers declines with age among those with a probable mental health condition, compared to a rise with age among other individuals, including those who are chronically physically ill. CONCLUSION: The main finding is less the sizeable gap in the percentage of savers among individuals who have and do not have a mental disorder th an the strong interaction with age. Older individuals with mental health conditions are at particular risk for having no savings and are at more risk than individuals in poor physical health . Low levels of saving among older individuals with mental health problems become particularly problematic when these individuals transition into Medicare. With limited household wealth, these individuals are the group least likely to be able to afford supplemental insurance that covers medications and least likely to be able to afford the out-of-pocket costs for newer psychotropic medications.
Adult↗
Health plan decision making in the Medicare population: results from a national randomized experiment.
OBJECTIVE: To examine the effect of providing the Medicare & You handbook on consumers' attitudes and behavior regarding health plan decision making. DATA SOURCE: A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed. Data were collected using a mail survey with telephone follow-up; the response rate was 76 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group that received no Medicare-related in formation as part of the study, or to a treatment group that received a copy of the 2000 version of the Medicare & You handbook as part of a national mailing. Half of the treat men t group (the "re-mail" group) received a second copy of the handbook along wit h their mail survey instrument. PRINCIPAL FINDINGS: The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values. Treatment group beneficiaries had a significantly higher propensity to either change or consider changing health plans relative to beneficiaries in the control group. Controlling for other factors, 5 percent of treatment group members switched health insurance plans during the prior month compared to 3 percent of control group members. there were no significant differences in predicted values between the re-mail and no re-mail groups in any of the models. Type of supplemental insurance was also highly related to all three outcomes. CONCLUSIONS: Findings from this and a prior parallel study suggest th at messages contained in the Medicare & You handbook can have an influence on beneficiaries and the Medicare market . Thus, careful attention should be given to the wording and intent of these messages. This is particularly relevant given the current administration's emphasis on increasing enrollment in Medicare+Choice plans and findings from earlier research reporting that beneficiaries felt the handbook was pressuring them to enroll in managed care.
Aged↗
Medicare program; Medicare secondary payer amendments. Interim final rule with comment period.
This interim final rule with comment period implements amendments to the Medicare Secondary Payer (MSP) provisions under Title III of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MMA amendments clarify the MSP provisions regarding the obligations of primary plans and primary payers, the nature of the insurance arrangements subject to the MSP rules, the circumstances under which Medicare may make conditional payments, and the obligations of primary payers to reimburse Medicare.
Humans↗
Medicare. Benefits and supplemental coverage.
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Insurance, Medigap↗
Private health insurance and medical care utilization: evidence from the Medicare population.
This paper examines the impact of supplemental health insurance policy ownership on the use of health care services by the elderly. It employs a data base consisting of Medicare claims data from over 2,000 beneficiaries in six states, actual copies of their supplemental insurance policies, and detailed survey information. The results show that policy ownership has a substantial, positive impact on service usage and costs, particularly for beneficiaries in fair or poor health. The greatest impact was found for policies that provide first-dollar coverage.
Aged↗
Ability to pay for retiree health benefits.
This paper examines retired persons who received employer-provided health benefits in 1987. The sociodemographic, health, and economic characteristics of these elderly persons are compared to the total elderly population. Two methods of estimating retiree insurance purchase are considered and indicate 13% to 20% of retirees would be unable to afford benefits without an employer subsidy. The percentage of persons unable to purchase the employer-provided benefits drops significantly if some subsidy is maintained. The results indicate substantial differences in ability to purchase insurance by sociodemographic characteristics. The future of retiree health benefits in a reformed health care system is discussed.
Aged↗
Vigilance brings victories on economic issues.
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Health Services↗
Shifting financial burdens: consequences for patients.
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Ambulatory Care↗
The impact of insurance on access to physician services for elderly people with arthritis.
The impact of insurance on access to physician services among elderly individuals with chronic illnesses has far-reaching policy implications. Using a national probability sample of aged Medicare beneficiaries (N = 5,543), and controlling for severity of illness, comorbidities, and other covariates, we analyze this issue for the most prevalent, chronic disabling disease among the elderly: arthritis. The results from the two-part multivariate model (logistic regression followed by ordinary least squares regression) suggest that insurance status is a positive and statistically significant predictor of both initial access to care (p < .01), and amount of arthritis care used (p < .05). Taking the results of the two-part model, we conducted a microsimulation to estimate the increase in Medicare spending that would result if various types of Medicare supplemental insurance were provided to those who had none. Results suggest that Medicare expenditures would rise from $51 million to $59 million annually depending on the type of supplement provided.
Activities of Daily Living↗
Operation start-up.
When Mount Carmel Health System sized up the Medicare market in Columbus, Ohio, executives liked what they saw: Seniors trusted them more than insurers to run a managed care plan. Only six months later, their provider-sponsored plan opened for business under a HCFA pilot project. Here's how Mount Carmel pulled it off.
Aged↗
The demand for Medicare supplemental insurance benefits: the role of attitudes toward medical care and risk.
This paper uses data from the 1987 National Medical Expenditure Survey to analyze the role that attitudes toward medical care and risk play in Medicare beneficiaries' demand for supplemental insurance. We investigate the factors affecting the demand for any supplemental insurance as well as specific Medigap benefits, such as coverage for Medicare's gaps in hospital and physician services, skilled nursing facility care, and prescription drug purchases. Our results indicate that attitudes significantly influence beneficiaries' decisions to purchase supplemental insurance and specific benefits with effects that are comparable in magnitude to those of self-reported health measures, education, and asset income.
Aged↗
Medicare spending by beneficiaries with various types of supplemental insurance.
The authors analyzed Medicare spending by elderly noninstitutionalized Medicare beneficiaries with and without supplemental insurance such as Medigap, employer-sponsored plans, and Medicaid. Use of a detailed survey of Medicare beneficiaries and their Medicare health insurance claims enabled the authors to control for health status, chronic conditions, functional limitations, and other factors that explain spending variations across supplemental insurance categories. The authors found that supplemental insurance was associated with a higher probability and level of Medicare spending, particularly for Part B services. Beneficiaries with both Medigap and employer plans had the highest levels of spending ceteris paribus, suggesting a possible moral hazard effect of insurance. Findings from this study are discussed in the context of the overall financing of health care for the elderly.
Aged↗
Supplemental insurance and use of effective cardiovascular drugs among elderly medicare beneficiaries with coronary heart disease.
CONTEXT: Cost-sharing in US prescription drug coverage plans for elderly persons varies widely. Evaluation of prescription drug use among elderly persons by type of health insurance could provide useful information for designing a Medicare drug program. OBJECTIVE: To determine use of effective cardiovascular drugs among elderly persons with coronary heart disease (CHD) by type of health insurance. DESIGN, SETTING, AND PATIENTS: Cross-sectional evaluation of 1908 community-dwelling adults, aged 66 years or older, with a history of CHD or myocardial infarction from the 1997 Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries. MAIN OUTCOME MEASURES: Use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), beta-blockers, and nitrates, and out-of-pocket expenditures for prescription drugs, stratified by type of health insurance: Medicare without drug coverage (Medicare only or self-purchased supplemental insurance) or with drug coverage (Medicaid, other public program, Medigap, health maintenance organization, or employer-sponsored plan). RESULTS: Statin use ranged from 4.1% in Medicare patients with no drug coverage to 27.4% in patients with employer-sponsored drug coverage (P<.001). Less variation between these 2 types occurred for beta-blockers (20.7% vs 36.1%; P =.003) and nitrates (20.4% vs 38.0%; P =.005). In multivariate analyses, statin use remained significantly lower for patients with Medicare only (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.05-0.49) and beta-blocker use was lower for Medicaid patients (OR, 0.55; 95% CI, 0.34-0.88) vs those with employer-sponsored coverage. Nitrate use occurred less frequently in persons lacking drug coverage (patients with Medicare only, P =.049; patients with supplemental insurance without drug coverage, P =.03). Patients with Medicare only spent a much larger fraction of income on prescription drugs compared with those with employer-sponsored drug coverage (7.9% vs 1.7%; adjusted P<.001). CONCLUSION: Elderly Medicare beneficiaries with CHD who lack drug coverage have disproportionately large drug expenditures and lower use rates of statins, a class of relatively expensive drugs that improve survival.
Aged↗
The impact of policy standardization on the Medigap market.
This study examines the impact of policy standardization on the market for Medicare supplemental, or "Medigap," policies. Prior to 1992, insurance carriers could sell any benefits they chose, so long as minimum benefit requirements were met. In July 1992, federal legislation was implemented that required all new Medigap policies to conform exactly to one of 10 standardized sets of benefits. Using pre- and post-standardized policy information from six states, this study analyzes the impact of this legislation. Overall, standardization has affected the market positively, and as a result, consumers are better able to make informed choices about the benefits they are purchasing.
Community Participation↗
Medicare program; conditional designation of States in which Medicare SELECT insurance policies may be issued--HCFA. General notice with comment period.
This notice announces the Secretary's conditional determination of the 15 States in which Medicare supplemental insurance policies (commonly referred to as "Medigap" policies) may be issued as Medicare SELECT policies. The Omnibus Budget Reconciliation Act of 1990 (OBRA '90), Public Law 101-508, amended section 1882 of the Social Security Act to provide for the simplification and standardization of Medicare supplemental insurance policies and to authorize the approval of Medicare SELECT policies in fifteen States, as determined by the Secretary, for a three-year period. Under State-approved Medicare SELECT policies, insurers may restrict full Medicare supplemental insurance benefits to items and services provided by a network of physicians and providers under contract with the insurer. This notice implements section 4358(c) of OBRA '90, which provides for the designation of the 15 States in which Medicare SELECT policies may be approved for issuance during the period January 1, 1992 through December 31, 1994.
Centers for Medicare and Medicaid Services, U.S.↗