Health Affairs

Posting date: December 15, 2004

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Health Affairs, 10.1377/hlthaff.w4.586
Copyright © 2004 by Project HOPE

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Medicare Advantage: Déjà Vu All Over Again?

Brian Biles ^1*, Geraldine Dallek ², Lauren Hersch Nicholas ³

¹ Brian Biles is a professor in the Department of Health Policy, George Washington University, in Washington, D.C.
² Geraldine Dallek is a Washington,D.C.-based health policy consultant.
³ Lauren Nicholas is a doctoral candidate in the School of Social Work, Columbia University, in New York City.

^*Corresponding author.

Abstract

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expands the role of private health plans in Medicare through prescription drug plans and a revised Medicare+Choice (M+C), renamed Medicare Advantage, program. This paper discusses the factors responsible for the failure of M+C to develop as intended in 1997 and analyzes the challenges for MMA implementation in light of these factors. They include making a complex program understandable to beneficiaries; addressing plans’ efforts to avoid enrolling high-cost beneficiaries; ensuring stability of benefits, providers, and plans; dealing with beneficiaries enrolled in unsuitable plans; providing equity of health benefits throughout the country; and controlling overall Medicare costs.

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

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