Health Affairs

Posting date: December 15, 2004

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Health Affairs, 10.1377/hlthaff.w4.572
Copyright © 2004 by Project HOPE

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Medicare Disadvantaged And The Search For The Elusive ‘Level Playing Field’

Robert A. Berenson ^1*

¹ Bob Berenson is a senior fellow at the Urban Institute in Washington, D.C. He is a former staff member of the Centers for Medicare and Medicaid Services, the federal agency responsible for Medicare.

^*Corresponding author.

Abstract

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) raised payment levels for established Medicare Advantage (private) local plans and would-be regional preferred provider organizations (PPOs). Even though plans on average receive about 108 percent of what would have been spent for the same beneficiaries in traditional Medicare, the Centers for Medicare and Medicaid Services (CMS) added another 2.3 percent in 2004 and 4.0 percent in 2005 in its implementation of risk-adjusted payments. Although MMA gives a clear preference to private plans to start a fundamental restructuring of Medicare, the question remains whether Congress will maintain overpayments to private plans when faced with the pressure to reduce budget deficits.

Key Words: Business Of Health, Consumer Issues, Health Reform, Managed Care - Medicare, Politics, Insurance Market

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				R. A. Berenson From Politics To Policy: A New Payment Approach In Medicare Advantage Health Aff., March 1, 2008; 27(2): w156 - w164. [Abstract] [Full Text] [PDF]