The effects of medicare advantage payment reductions on low income elderly medicare beneficiaries

医疗保险优惠付款减少对低收入老年医疗保险受益人的影响

• 批准号: 9007185
• 负责人: ADAM J ATHERLY
• 金额: $ 23.31万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9007185
• 关键词: effects; medicare; advantage; payment; reductions

 DESCRIPTION (provided by applicant): The purpose of the proposed research is to estimate the effects of the reductions in government payments to Medicare Advantage (MA) plans, required by the 2010 Patient Protection and Affordable Care Act (ACA), on low-income Medicare beneficiaries. MA plans receive a monthly capitation payment from Medicare for each enrollee, adjusted for the enrollee's risk. Previous research has shown that plans respond to higher payment rates by offering enhanced benefits and/or lower out-of-pocket premiums. This is true both geographically (i.e., plans in counties with higher payment rates offer more benefits than plans in lower payment areas) and over time. The ACA substantially reduced MA plan payments, with the Congressional Budget Office (CBO) estimating that the new payment formula in the ACA will reduce MA payments by $132 billion over ten years. This will lead MA plans to reduce benefits and shift costs from the plans to beneficiaries. The policy issue is that low-income Medicare beneficiaries who are above the Medicaid (dual- eligible) threshold are a key constituency for MA plans. Low-income beneficiaries struggle to pay Medicare fee-for-service (FFS) cost sharing, which makes MA plans with enhanced benefits particularly appealing. If MA plans respond to reduced payments as they did to the payment cuts resulting from the 1997 Balanced Budget Act, they will reduce their supplementary benefits, increase out-of-pocket premiums, or withdraw from the market, potentially leading to access problems for low-income MA plan enrollees. The purpose of the proposed research is to estimate the effect of the ACA-mandated reductions in government payments to Medicare Advantage plans on low-income beneficiaries and to investigate possible policy responses to "hold them harmless" from the payment cuts. Methodologically, we will combine a number of different data sources to create a panel dataset that is nationally representative of the Medicare population. We analyze the impact of payment cuts on both beneficiary premiums and beneficiary out-of-pocket costs (OOPC); the impact of changes in premiums and OOPC on Medicare plan choice by beneficiaries; and ultimately the impact on the economic welfare of low-income beneficiaries. The results of this study will advance both the academic literature on health plan choice and provide guidance to policy- makers regarding both the impact of payment cuts on low-income beneficiaries and the cost of policy solutions to mitigate the impact.

 说明（由申请人提供）：拟议研究的目的是评估政府根据 2010 年《患者保护和平价医疗法案》(ACA) 的要求减少对 Medicare Advantage (MA) 计划的付款对低收入人群的影响医疗保险受益人每月从医疗保险中为每位参保者支付按人头付费，并根据参保者的风险进行调整。之前的研究表明，计划通过提供更高的福利和/或降低自付费用来应对更高的支付率。从地理上看（即缴费率较高的县的计划比缴费率较低的地区的计划提供更多福利）和随着时间的推移，ACA 都大幅减少了 MA 计划的缴费，国会预算办公室 (CBO) 估计，这一点也是如此。 ACA 中的新支付公式将在十年内减少 MA 支付额 1320 亿美元，这将导致 MA 计划减少福利并将成本从计划转移给受益人。双重的-低收入受益人难以支付医疗保险服务费 (FFS) 费用分摊，这使得具有增强福利的 MA 计划特别有吸引力，如果 MA 计划像他们那样应对减少的付款。由于 1997 年《平衡预算法》导致的付款削减，他们将减少补充福利、增加自付费用或退出市场，这可能会导致低收入 MA 计划参与者的准入问题。估计平价医疗法案规定的政府减少医疗保险优惠计划付款对低收入受益人的影响，以及可能采取的政策应对措施，以“让他们不受伤害地调查”付款削减。创建一个代表全国医疗保险人口的面板数据集，我们分析了付款削减对受益人保费和受益人自付费用 (OOPC) 的影响；以及保费和 OOPC 变化的影响。受益人的医疗保险计划选择；以及最终对低收入受益人经济福利的影响。这项研究的结果将推进有关健康计划选择的学术文献，并为政策制定者提供有关减费影响的指导。低收入受益人以及减轻影响的政策解决方案的成本。