Identifying Coding Intensity in Medicare Advantage Through Switchers.

Objective: To estimate the extent of differential coding of health risk in traditional Medicare (TM) compared with Medicare Advantage (MA).

Study Setting And Design: Payments to MA plans are based on reported medical conditions, and research has shown the number and severity of diagnoses are larger when beneficiaries are enrolled in MA plans rather than TM. We compare the risk scores of Medicare beneficiaries who switch from TM into MA over the 2013-2021 period to the scores of beneficiaries who stay in TM, incorporating heterogeneous treatment effects across switching cohorts and over time.

Changes in coverage stability and churning for private, individual insurance under the Affordable Care Act.

The Affordable Care Act (ACA) transformed the market for individual insurance. Using the 2-year panels of the Household Component of the Medical Expenditure Panel Survey covering the 2002-2022 period and controlling for the business cycle and other factors, we find the share of nonelderly adults enrolled in individual insurance doubled under the ACA. The percentage of adults covered by individual insurance 1-23 months more than doubled, and the percentage with at least 24 months rose 80% in states that did not expand Medicaid.

Newly and Previously Eligible Medicaid Enrollees Differ, but Not in Health Care Expenditures.

In 2014, the Affordable Care Act (ACA) expanded the role of Medicaid by encouraging states to increase eligibility for lower-income adults. As of 2024, 10 states had not adopted the expanded eligibility provisions of the ACA, possibly due to concerns about the state's share of spending. Using the Medical Expenditure Panel Survey (MEPS), we documented how health care utilization, expenditures, and the overall health status of newly eligible enrollees compare with enrollees who would have been eligible under their states' rules before the ACA.

In-Home Health Risk Assessments And Chart Reviews Contribute To Coding Intensity In Medicare Advantage.

There is widespread agreement that taxpayers pay more when Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans than if those beneficiaries were enrolled in traditional Medicare. MA plans are paid on the basis of submitted diagnoses and thus have a clear incentive to encourage providers to find and report as many diagnoses for their enrollees as possible. Two mechanisms that MA plans use to identify diagnoses that are not available for beneficiaries in traditional Medicare are in-home health risk assessments and chart reviews.

Horizontal and vertical equity and public subsidies for private health insurance in the U.S.

The United States offers two markedly different subsidy structures for private health insurance. When covered through employer-based plans, employees and their dependents benefit from the exclusion from taxable income of the premiums. Individuals without access to employer coverage may obtain subsidies for Marketplace coverage.

Changes In Health Coverage During The COVID-19 Pandemic.

The COVID-19 pandemic had the potential to alter patterns of health insurance coverage in the US. Using data from the Medical Expenditure Panel Survey, we found increased stability of Medicaid coverage for children and nonelderly adults during the first year of the pandemic. Fewer people who had Medicaid in 2019 became uninsured in 2020 (4.

Changes in preventive service use by race and ethnicity after medicare eligibility in the United States.

Use of recommended preventive care services in the United States is not universal and varies considerably by socio-economic status. We examine whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using data across 12 cycles of the Household Component of the Medical Expenditure Panel Survey (2005-2016), we employ a regression discontinuity design to assess changes in the use of preventive services.

ACA Marketplaces Became Less Affordable Over Time For Many Middle-Class Families, Especially The Near-Elderly.

The Affordable Care Act provides tax credits for Marketplace insurance, but before 2021, families with incomes above four times the federal poverty level did not qualify for tax credits and could face substantial financial burdens when purchasing coverage. As a measure of affordability, we calculated potential Marketplace premiums as a percentage of family income among families with incomes of 401-600 percent of poverty. In 2015 half of this middle-class population would have paid at least 7.

The Impact Of Medicare On Access To And Affordability Of Health Care.

Medicare pays for roughly one in four physician visits in the United States, yet a rigorous understanding of how Medicare currently affects access to and affordability of care for its enrollees is unavailable. Using data from the Medical Expenditure Panel Survey-Household Component and the National Health Interview Survey, I tested for changes in access to care and affordability around age sixty-five, when most people gain eligibility for Medicare. I found that Medicare eligibility is associated with a 1.

Medicare Advantage and postdischarge quality: evidence from hospital readmissions.

Objectives: To compare relative readmission rates for beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM) as suggestive evidence of changes in postdischarge care coordination and the quality of care delivered to Medicare beneficiaries.

Study Design: We used the Agency for Healthcare Research and Quality's 2009 and 2014 Healthcare Cost and Utilization Project State Inpatient Databases for 4 states with reliable sources of payment identifiers, linking these data to local area characteristics. Our outcome was the probability of a hospital readmission within 30 days of an index admission.

The effects of coding intensity in Medicare Advantage on plan benefits and finances.

Objective: To assess how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity.

Data Sources/study Setting: MA plan characteristics and administrative records from the Centers for Medicare and Medicaid Services (CMS) for the sample of beneficiaries enrolled in both MA and Part D between 2008 and 2015. Medicare claims and drug utilization data for Traditional Medicare (TM) beneficiaries were used to calibrate an independent measure of health risk.

Changes In The Equity Of US Health Care Financing In The Period 2005-16.

Spending on health care in the United States amounted to 17.9 percent of gross domestic product in 2017. Households paid for this care through out-of-pocket medical spending and a complex mix of out-of-pocket premiums, employer premium contributions, taxes, and subsidies that combined to finance private employer-sponsored insurance, nongroup insurance, and multiple public insurance programs.

Despite Coverage Gains, One-Third Of People In Small-Firm Low-Income Families Were Uninsured In 2014-15.

Obtaining health insurance coverage has historically been challenging for workers at small firms and the self-employed. Using data from the Medical Expenditure Panel Survey, we found that the overall uninsurance rate for these workers and their families declined by 5 percentage points over the past decade, but one-third of those with lower incomes remained uninsured in 2014-15.

Getting What We Pay For: How Do Risk-Based Payments to Medicare Advantage Plans Compare with Alternative Measures of Beneficiary Health Risk?

Objective: To estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM).

Data Sources/study Setting: Medicare claims and enrollment records for the sample of beneficiaries enrolled in Part D between 2008 and 2015.

Study Design: We assigned therapeutic classes to Medicare beneficiaries based on their prescription drug utilization.

Newly Eligible Enrollees In Medicaid Spend Less And Use Less Care Than Those Previously Eligible.

Understanding the health care spending and utilization of various types of Medicaid enrollees is important for assessing the budgetary implications of both expansion and contraction in Medicaid enrollment. Despite the intense debate surrounding the Affordable Care Act (ACA), however, little information is available on the spending and utilization patterns of the nonelderly adult enrollees who became newly eligible for Medicaid under the ACA. Using data for 2012-14 from the Medical Expenditure Panel Survey, we compared health care spending and utilization of newly eligible Medicaid enrollees with those of nondisabled adults who were previously eligible and enrolled.

How do Medicare Advantage beneficiary payments vary with tenure?

Objectives: To compare how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans.

Study Design: Descriptive and fixed effects regression analyses.

Methods: Using linked administrative enrollment and plan data, we compared the costs of the MA plans that beneficiaries chose with the costs of other plans available to them.

Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims.

The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants' health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims.

Adults Are More Likely To Become Eligible For Medicaid During Future Recessions If Their State Expanded Medicaid.

Eligibility for and enrollment in Medicaid can vary with economic recessions, recoveries, and changes in personal income. Understanding how Medicaid responds to such forces is important to budget analysts and policy makers tasked with forecasting Medicaid enrollment. We simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states.

Changes In Health Status And Care Use After ACA Expansions Among The Insured And Uninsured.

Following the Affordable Care Act's insurance expansion provisions in 2014, the average health status and use of health care within coverage groups has likely changed. Medicaid enrollees and the uninsured were both healthier in 2014 than those respective groups were in 2013. By contrast, those with individual private insurance coverage appeared less healthy as a group.

Insurer Competition In Federally Run Marketplaces Is Associated With Lower Premiums.

Federal subsidies for health insurance premiums sold through the Marketplaces are tied to the cost of the benchmark plan, the second-lowest-cost silver plan. According to economic theory, the presence of more competitors should lead to lower premiums, implying smaller federal outlays for premium subsidies. The long-term impact of the Affordable Care Act on government spending will depend on the cost of these premium subsidies over time, with insurer participation and the level of competition likely to influence those costs.

Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?

Objectives: To evaluate the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D.

Study Design: We matched respondents in the 2008 Medicare Current Beneficiary Survey to the Medicare Advantage (MA) plans available to them using the Bid Pricing Tool and previously unavailable data on beneficiaries' plan choices.

Methods: We estimated a 2-stage nested logit model of Medicare plan choice decision making, including the decision to choose traditional fee-for-service (FFS) Medicare or an MA plan, and for those choosing MA, which specific plan they chose.

Comparing the assets of uninsured households to cost sharing under high-deductible health plans.

Financial assets are relevant when one is assessing whether high-deductible plans, which require greater up-front cost sharing, are worthwhile for the uninsured. We show that uninsured households have less financial assets compared to the insured; at lower income levels, their net financial assets may even be negative. Although lower premiums may increase the ability of the uninsured to buy some coverage, high out-of-pocket liability may leave families exposed to costs that they cannot meet.