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Medicare preferred provider organization demonstration: plan offerings and beneficiary enrollment.

Pope GC, Greenwald L, Kautter J, Olmsted E, Mobley L - Health Care Financ Rev (2006)

Bottom Line: As preferred provider organizations (PPOs) become the dominant model of managed health care in the private sector, policymakers have increasingly viewed PPOs as an attractive option for Medicare.In part to understand how PPOs might operate under the Medicare Program, CMS launched the Medicare PPO demonstration in January 2003.In this article, we examine how PPOs have operated so far under the demonstration, including PPO availability and market entry; premiums, benefits, and beneficiary cost sharing; and enrollment, market share, enrollee characteristics, and disenrollment to date.

View Article: PubMed Central - PubMed

Affiliation: RTI International, Waltham, MA 02452, USA. gpope@rti.org

ABSTRACT
As preferred provider organizations (PPOs) become the dominant model of managed health care in the private sector, policymakers have increasingly viewed PPOs as an attractive option for Medicare. In part to understand how PPOs might operate under the Medicare Program, CMS launched the Medicare PPO demonstration in January 2003. In this article, we examine how PPOs have operated so far under the demonstration, including PPO availability and market entry; premiums, benefits, and beneficiary cost sharing; and enrollment, market share, enrollee characteristics, and disenrollment to date.

Show MeSH
Predicted Out-of-Pocket Cost, by Plan Type for Beneficiaries Age 70-74
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Related In: Results  -  Collection


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f3-hcfr-27-3-095: Predicted Out-of-Pocket Cost, by Plan Type for Beneficiaries Age 70-74

Mentions: Enrollees in demonstration PPOs have higher predicted total out-of-pocket costs than enrollees in competing CCPs at all health status levels, but the difference narrows as health declines. PPOs (and CCPs) provide better protection from financial risk as health declines than FFS Medicare, but less protection than FFS supplemented with the most popular Medigap plan. Table 2 reports typical (median) cost sharing for selected services for PPOs (in network and out of network), competing CCPs, and original Medicare FFS. Figure 3 shows the implications of these cost-sharing rules for total beneficiary out-of-pocket expenses. In addition to cost sharing (which includes expenses for uncovered services), the total out-of-pocket costs shown in Figure 3 include premiums (Part B and health plan) and prescription drug expenses (assuming no drug coverage beyond what is offered by the health plan). For all types of plans, in-network cost-sharing levels are assumed to determine total out-of-pocket costs. In our analysis, we summarized total out-of-pocket costs by plan type for enrollees in excellent, good, and poor health, age 70–74.9 Plan types are demonstration PPOs, competing CCPs, original Medicare FFS, and original Medicare plus competing Medigap Plan F. Plan type costs are unweighted averages across plans of a given type; for example, an average of the 61 PPO demonstration plans.


Medicare preferred provider organization demonstration: plan offerings and beneficiary enrollment.

Pope GC, Greenwald L, Kautter J, Olmsted E, Mobley L - Health Care Financ Rev (2006)

Predicted Out-of-Pocket Cost, by Plan Type for Beneficiaries Age 70-74
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4194956&req=5

f3-hcfr-27-3-095: Predicted Out-of-Pocket Cost, by Plan Type for Beneficiaries Age 70-74
Mentions: Enrollees in demonstration PPOs have higher predicted total out-of-pocket costs than enrollees in competing CCPs at all health status levels, but the difference narrows as health declines. PPOs (and CCPs) provide better protection from financial risk as health declines than FFS Medicare, but less protection than FFS supplemented with the most popular Medigap plan. Table 2 reports typical (median) cost sharing for selected services for PPOs (in network and out of network), competing CCPs, and original Medicare FFS. Figure 3 shows the implications of these cost-sharing rules for total beneficiary out-of-pocket expenses. In addition to cost sharing (which includes expenses for uncovered services), the total out-of-pocket costs shown in Figure 3 include premiums (Part B and health plan) and prescription drug expenses (assuming no drug coverage beyond what is offered by the health plan). For all types of plans, in-network cost-sharing levels are assumed to determine total out-of-pocket costs. In our analysis, we summarized total out-of-pocket costs by plan type for enrollees in excellent, good, and poor health, age 70–74.9 Plan types are demonstration PPOs, competing CCPs, original Medicare FFS, and original Medicare plus competing Medigap Plan F. Plan type costs are unweighted averages across plans of a given type; for example, an average of the 61 PPO demonstration plans.

Bottom Line: As preferred provider organizations (PPOs) become the dominant model of managed health care in the private sector, policymakers have increasingly viewed PPOs as an attractive option for Medicare.In part to understand how PPOs might operate under the Medicare Program, CMS launched the Medicare PPO demonstration in January 2003.In this article, we examine how PPOs have operated so far under the demonstration, including PPO availability and market entry; premiums, benefits, and beneficiary cost sharing; and enrollment, market share, enrollee characteristics, and disenrollment to date.

View Article: PubMed Central - PubMed

Affiliation: RTI International, Waltham, MA 02452, USA. gpope@rti.org

ABSTRACT
As preferred provider organizations (PPOs) become the dominant model of managed health care in the private sector, policymakers have increasingly viewed PPOs as an attractive option for Medicare. In part to understand how PPOs might operate under the Medicare Program, CMS launched the Medicare PPO demonstration in January 2003. In this article, we examine how PPOs have operated so far under the demonstration, including PPO availability and market entry; premiums, benefits, and beneficiary cost sharing; and enrollment, market share, enrollee characteristics, and disenrollment to date.

Show MeSH