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: 9134671
• 负责人: ADAM J ATHERLY
• 金额: $ 15.1万
• 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 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9134671
• 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.

 描述（由适用提供）：拟议研究的目的是估计2010年《 2010年患者保护和负担得起的护理法》（ACA）要求的政府付款减少对Medicare Advantage（MA）计划的影响，对低收入医疗保险受益人的影响。 MA计划每月从Medicare获得每个注册人的每月资本付款，并针对入学人的风险进行了调整。先前的研究表明，计划通过提供增强的福利和/或较低的自付额保费来响应更高的付款率。在地理上，这都是事实（即，付款利率较高的县的计划比较低的支付区域的计划和随着时间的推移提供了更多的收益）和随着时间的流逝。 ACA大大减少了MA计划付款，国会预算办公室（CBO）估计，ACA中的新付款公式将在十年内将MA付款减少1320亿美元。这将领导MA计划，以降低利益并将成本从福利计划转移。政策问题是，高于医疗补助（双重资格）阈值的低收入医疗保险受益人是MA计划的关键组成部分。低收入受益人努力支付医疗保险费用（FFS）成本分配，这使MA计划具有增强的收益，尤其是出现。如果MA计划对减少付款的响应对1997年平衡预算法的付款削减的付出，那么他们将降低其补充福利，增加自付费用或退出市场，这可能会导致低收入MA Plan计划的访问问题。拟议的研究的目的是估计政府支付对Medicare Advantage Advantage Progants对低收入福利的付款减少的影响，并调查可能从削减付款中“无害”“无害”的政策响应。从方法上，我们将结合许多不同的数据源，以创建一个针对医疗保险的好处，我们分析了对医疗保险的好处。自付费用（OOPC）;最终，对受益人的医疗保险计划的变化以及对低收入受益人的经济福利的影响；