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Medicare Advantage

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Journal Article
J Health Polit Policy Law (2007) 32 (2): 317–347.
Published: 01 April 2007
...John H. Cawley; Andrew B. Whitford In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which required that in 2006 the Centers for Medicare and Medicaid Services (CMS) implement a system of competitive bids to set payments for the Medicare Advantage program...
Journal Article
J Health Polit Policy Law (2023) 48 (6): 919–950.
Published: 01 December 2023
...Erin C. Fuse Brown; Travis C. Williams; Roslyn C. Murray; David J. Meyers; Andrew M. Ryan Abstract The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders now argue that Medicare...
Journal Article
J Health Polit Policy Law (2021) 46 (4): 627–639.
Published: 01 August 2021
..., while Medicare Advantage plans successfully compete with traditional Medicare only because their payment rates are tied by regulation to those in the traditional Medicare program. However, Medicare has not succeeded in implementing new, value-based payment approaches that also would serve as models...
Journal Article
J Health Polit Policy Law (2016) 41 (3): 315–354.
Published: 01 June 2016
...Andrew S. Kelly Abstract In 2014, Medicare Advantage (MA) enrollment surpassed 30 percent of eligible beneficiaries. Twenty-five years earlier, enrollment hovered at just 3 percent. The expansion of private Medicare plans presents a puzzling instance of policy change within Medicare—a program long...
FIGURES | View All (6)
Journal Article
J Health Polit Policy Law (2005) 30 (3): 453–474.
Published: 01 June 2005
... or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have...
Journal Article
J Health Polit Policy Law 11186111.
Published: 07 February 2024
... in Medicare Advantage plans, little work has examined the impact of these denials for patients enrolled in different types of public and private insurance. I argue that the process of appealing insurers' denials imposes administrative burdens on patients in ways that are not equitable, deepening the divide...
Journal Article
J Health Polit Policy Law (2016) 41 (4): 697–716.
Published: 01 August 2016
... . doi:10.1056/NEJMp1208465 . Stevenson David G. , Ayanian John Z. , Zaslavsky Alan M. , Newhouse Joseph P. , and Landon Bruce E. 2013 . “ Service Use at the End-of-Life in Medicare Advantage versus Traditional Medicare .” Medical Care 51 , no. 10 : 931 – 37...
Journal Article
J Health Polit Policy Law (2019) 44 (6): 937–954.
Published: 01 December 2019
... ) to Medicare Advantage (Haeder 2019 ). Some states, like California, have followed suit (Covered California 2017 ; Haeder, Weimer, and Mukamel 2015b ). Yet the Trump Administration's reversal shows a lack of consensus on a more quantitative approach. Moreover, compliance monitoring is not always assigned...
Journal Article
J Health Polit Policy Law (2023) 48 (3): 435–450.
Published: 01 June 2023
... and Consequences of COVID-19: A Gathering Storm .” Journal of the American Medical Association 326 , no. 19 : 1909 – 10 . HHS (US Department of Health and Human Services, Office of Inspector General) . 2022 . “ Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns...
Journal Article
J Health Polit Policy Law (2013) 38 (3): 479–504.
Published: 01 June 2013
...’ measure reports only the administrative costs incurred by the federal government (i.e., by CMS as well as other federal agencies that contribute to the operation of Medicare), while the NHEA reports those costs as well as the administrative costs incurred by Medicare Advantage plans and Part D...
Journal Article
J Health Polit Policy Law (2014) 39 (2): 467–482.
Published: 01 April 2014
... of Medicare beneficiaries were in such plans. By 2013, over one in four Medicare beneficiaries (28 percent) had enrolled in a private insurance plan under Medicare Advantage, and enrollment growth continued apace despite cuts to plan payments under the Affordable Care Act. Further, Medicare's Part D benefit...
Journal Article
J Health Polit Policy Law (2018) 43 (4): 707–730.
Published: 01 August 2018
... Progressive reform Medicare buy-in Medicare Advantage marketplaces universal coverage There is no way to understand the path of health care reform in the United States without understanding the role of counterreform. Every successful progressive reform in health policy has been adopted in response...
Journal Article
J Health Polit Policy Law (2021) 46 (4): 535–547.
Published: 01 August 2021
... Medicare Advantage. All these changes brought Biden's plan much closer to his progressive campaign rivals'. In 2009, the public option was tacked onto a proposal drawn largely from the Massachusetts experience. Today, it is at the center of an integrated vision that would fundamentally transform...
Journal Article
J Health Polit Policy Law (2015) 40 (4): 689–703.
Published: 01 August 2015
... ACOs, we use the share of privately insured individuals who are enrolled in an HMO, and for Medicare ACOs we use the share of Medicare beneficiaries who are enrolled in Medicare Advantage. Both are from the 2009 HealthLeaders-InterStudy survey. We construct hospital concentration indexes from...
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Journal Article
J Health Polit Policy Law (2014) 39 (2): 263–293.
Published: 01 April 2014
..., such as primary care physicians in underserved areas. The ACA also reduces subsidies to commercial Medicare Advantage plans and increases the Medicare tax for wealthy individuals (Davis et al. 2010 ; KFF 2010b ). These financing and payment changes engendered claims that the ACA makes harmful cuts...
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Journal Article
J Health Polit Policy Law (2020) 45 (5): 847–861.
Published: 01 October 2020
... more expansive regulatory revisions under the Trump administration (CMS 2019 ), has permitted Medicare Advantage (MA) plans to offer nonmedical supportive services, including nonmedical transportation, home-delivered meals, adult day services, nonmedical in-home support, respite care, and home...
Journal Article
J Health Polit Policy Law (2011) 36 (3): 555–563.
Published: 01 June 2011
...-reform/when-medicare-is-the-piggy-bank (accessed October 27, 2010) . Berenson R. A. Dowd B. . 2009 . Medicare Advantage Plans at a Crossroads — Yet Again . Health Affairs (online) 28 : W29 – W40 . Blendon R. J. Benson J. M. . 2010 . Health Care in the 2010 Election...
Journal Article
J Health Polit Policy Law (2020) 45 (6): 1107–1136.
Published: 01 December 2020
... public and private insurers have recognized the implications of transportation barriers and have incorporated nonemergency medical transportation into their plan designs. These insurers include, for example, some Accountable Care Organizations (Fraze et al. 2016 ), Medicare Advantage plans (Pope 2016...
FIGURES | View All (6)
Journal Article
J Health Polit Policy Law (2014) 39 (1): 209–235.
Published: 01 February 2014
...., a drug plan that covers their prescriptions). Findings provide hints of what government can do to support competition in such markets. We first examine the Medicare program, which has three markets where beneficiaries choose among health insurance plans: Part C, the Medicare Advantage program; Part D...
Journal Article
J Health Polit Policy Law (2023) 48 (1): 63–92.
Published: 01 February 2023
... and Payers Bear .” Health Affairs 9 , no. 31 : 1951 – 58 . Freed Meredith , Biniek Jeannie F. , Damico Anthony , and Neuman Tricia . 2021 . “ Medicare Advantage in 2021: Enrollment Update and Key Trends .” Kaiser Family Foundation, June 21 . https://www.kff.org/medicare...
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