Trends in Medicare supplemental insurance and prescription drug coverage, 1996-1999.
(9/24)
Medicare Current Beneficiary Survey (MCBS) Access to Care data indicate a five-percentage-point decline in the share of Medicare beneficiaries having Medigap coverage between 1996 and 1999; this was matched by a commensurate rise in the share enrolled in Medicare HMOs, contributing to an increase in the percentage with drug coverage. During this period, high-income beneficiaries, and to a lesser extent healthier and rural beneficiaries, experienced greater net declines in supplemental coverage and smaller relative gains in drug coverage, compared with others. By fall 1999, 38 percent of beneficiaries lacked drug coverage, based on point-in-time estimates. This is much higher than previous estimates that measured beneficiaries' drug coverage at any time during the calendar year. Many of Medicare's most vulnerable beneficiaries--rural (50 percent), near-poor (44 percent), and oldest old (45 percent)--were most likely to lack drug coverage in the fall of 1999. (+info)
The effect of the illness episode approach on Medicare beneficiaries' health insurance decisions.
(10/24)
This article reports on a quasi-experimental test of the Illness Episode Approach (IEA), a new approach to providing Medicare beneficiaries with information about the financial consequences of alternative health care coverage decisions. Beneficiaries were randomly assigned to free, three-hour workshops, half using materials developed through application of the IEA, half using traditional comparative information on insurance options. Analysis of data collected before and after the workshops indicates that participants in the Illness Episode sessions were more likely to drop duplicative coverage, to spend less on premiums, and to report that their decisions to change coverage had met their expectations. The entire sample of workshop participants showed significant increases in knowledge of Medicare and their own insurance, as well as improved satisfaction with the cost of their health care coverage. (+info)
New dimensions of economic well-being among people with mental illness: evidence from Healthcare for Communities.
(11/24)
OBJECTIVE: To analyze the relationship between mental health and savings and compare it to the relationship between common chronic physical conditions and savings. DATA SOURCE: Healthcare for Communities, a national survey conducted in 1997/1998 with approximately 10,000 respondents. STUDY DESIGN: We used logistic regression to analyze any savings versus no savings and used ordinary least squares regression to study level of savings conditional on having any savings. PRINCIPAL FINDINGS: Individuals screening positive for any mental health disorder are less than two-thirds as likely as individuals with no mental health problems to have any savings. The percent age of savers declines with age among those with a probable mental health condition, compared to a rise with age among other individuals, including those who are chronically physically ill. CONCLUSION: The main finding is less the sizeable gap in the percentage of savers among individuals who have and do not have a mental disorder th an the strong interaction with age. Older individuals with mental health conditions are at particular risk for having no savings and are at more risk than individuals in poor physical health . Low levels of saving among older individuals with mental health problems become particularly problematic when these individuals transition into Medicare. With limited household wealth, these individuals are the group least likely to be able to afford supplemental insurance that covers medications and least likely to be able to afford the out-of-pocket costs for newer psychotropic medications. (+info)
Health plan decision making in the Medicare population: results from a national randomized experiment.
(12/24)
OBJECTIVE: To examine the effect of providing the Medicare & You handbook on consumers' attitudes and behavior regarding health plan decision making. DATA SOURCE: A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed. Data were collected using a mail survey with telephone follow-up; the response rate was 76 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group that received no Medicare-related in formation as part of the study, or to a treatment group that received a copy of the 2000 version of the Medicare & You handbook as part of a national mailing. Half of the treat men t group (the "re-mail" group) received a second copy of the handbook along wit h their mail survey instrument. PRINCIPAL FINDINGS: The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values. Treatment group beneficiaries had a significantly higher propensity to either change or consider changing health plans relative to beneficiaries in the control group. Controlling for other factors, 5 percent of treatment group members switched health insurance plans during the prior month compared to 3 percent of control group members. there were no significant differences in predicted values between the re-mail and no re-mail groups in any of the models. Type of supplemental insurance was also highly related to all three outcomes. CONCLUSIONS: Findings from this and a prior parallel study suggest th at messages contained in the Medicare & You handbook can have an influence on beneficiaries and the Medicare market . Thus, careful attention should be given to the wording and intent of these messages. This is particularly relevant given the current administration's emphasis on increasing enrollment in Medicare+Choice plans and findings from earlier research reporting that beneficiaries felt the handbook was pressuring them to enroll in managed care. (+info)
Medicare program; Medicare secondary payer amendments. Interim final rule with comment period.
(13/24)
This interim final rule with comment period implements amendments to the Medicare Secondary Payer (MSP) provisions under Title III of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MMA amendments clarify the MSP provisions regarding the obligations of primary plans and primary payers, the nature of the insurance arrangements subject to the MSP rules, the circumstances under which Medicare may make conditional payments, and the obligations of primary payers to reimburse Medicare. (+info)
Estimation of a hedonic pricing model for Medigap insurance.
(14/24)
OBJECTIVE: This paper uses a unique database to examine premiums paid by beneficiaries for Medigap supplemental coverage. Average premiums charged by insurers are reported, as well as premiums by enrollee age and gender, and additional policy characteristics. Marginal prices for Medigap benefits are estimated using hedonic price regressions. In addition, the paper considers how additional policy characteristics and geographic differences in the use and cost of medical care affect premiums. DATA SOURCES/STUDY SETTING: A comprehensive database on premiums paid by beneficiaries for newly issued Medigap policies in the year 2000 along with state-level characteristics. STUDY DESIGN: Hedonic pricing equations are used to estimate implicit prices for Medigap benefits. DATA COLLECTION/EXTRACTION METHODS: The Centers for Medicare & Medicaid Services contracted for the creation of a detailed database on Medigap premiums. Data were collected in three stages. First, letters were sent directly to insurers requesting premium data. Second, letters were directly to state insurance commissioner's offices requesting premium data. Last, each state insurance commissioner's office was visited to collect missing data. PRINCIPAL FINDINGS: With the exceptions of the part B deductible and drug benefit, Medigap supplemental insurance is priced consistent with the actuarial value of benefits offered under the standardized plans. Premiums vary substantially based on rating method, whether the policy is guaranteed issue, Medigap Select, or explicitly for smokers. Premiums increase with enrollee age, but do not vary between men and women. The relationship between premiums and enrollee age varies across rating methods. Attained-age policies show the strongest relationship between age and premiums, while community-rated premiums, by definition, do not vary with age. Medigap supplemental insurance premiums are higher in states with poorer health, greater utilization, and greater managed care penetration. CONCLUSIONS: Despite the high cost, Medigap plans are generally priced in accordance with the actuarial value of benefits. The primary exception is the drug benefit, which appears to be subject to substantial adverse selection. Benefits such as the part B deductible and at-home recovery benefit offer little value to consumers. Several states require insurers to community rate premiums. Such regulation has important implications for premiums, and research needs to consider the impact of such regulation on the Medigap market. (+info)
Medigap coverage and Medicare spending: a second look.
(15/24)