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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 (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 (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...
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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 (2016) 41 (4): 697–716.
Published: 01 August 2016
... (Stevenson 2012 ). Since its creation in 1983, the Medicare hospice benefit has been “carved out” of the Medicare Advantage managed care program. Medicare Advantage plans are capitated by Medicare and must offer a benefit package that is actuarially comparable to that available to beneficiaries...
Journal Article
J Health Polit Policy Law (2019) 44 (6): 937–954.
Published: 01 December 2019
... Medicare Advantage and employer-sponsored insurance (Haeder, forthcoming ; Hall and Frostin 2016 ). Narrowing provider networks has been shown to serve as one of the few remaining legal options for insurers to contain costs (Dafny et al. 2017 ; Polsky, Cidav, and Swanson 2016 ). The underlying...
Journal Article
J Health Polit Policy Law (2023) 48 (3): 435–450.
Published: 01 June 2023
... another barrier to Medicare for All. States that complain loudly about the costs of funding their share of Medicaid are nonetheless unlikely to welcome a plan that sidelines Medicaid and diminishes their role in health policy making. In Medicare itself, the rise of enrollment in private Medicare Advantage...
Journal Article
J Health Polit Policy Law (2024) 49 (4): 539–565.
Published: 01 August 2024
... denials within the Medicare Advantage setting, and Dunn and colleagues ( 2023 ) examine claim denials and resubmissions across Medicare, Medicaid, and commercial insurance, scholars have overlooked the patient experience of coverage denials as well as the ways in which this practice can reinforce...
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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
... by the federal government, pay prices negotiated by Medicare, and include a drug benefit that also bargained for lower prices. In other words, it would resemble the public insurance side of Medicare, as opposed to regulated private plans of the sort provided through Medicare Advantage. All these changes brought...
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
... Savings.” n.d. January 8, 2013 www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdf Cooper Alicia Trivedi Amal N. “Fitness Memberships and Favorable Selection in Medicare Advantage Plans.” New England Journal of Medicine 2012 336 no. 2 150 57 Davis...
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Journal Article
J Health Polit Policy Law (2020) 45 (5): 847–861.
Published: 01 October 2020
... with progressively 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...
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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
... in 2019 (Gonzalez-Smith et al. 2020 ). However, the actual impact of ACOs on Medicare spending remains much debated. Here, we focus on spending within the traditional Medicare program; we address spending outside the traditional Medicare program (including in Medicare Advantage) later in the article...
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