Biles Brian, Casillas Giselle, Guterman Stuart
School of Public Health and Health Services, The George Washington University.
Issue Brief (Commonw Fund). 2016 Jan;2:1-9.
The costs of providing benefits to enrollees in private Medicare Advantage (MA) plans are slightly less, on average, than what traditional Medicare spends per beneficiary in the same county. However, MA plans that are able to keep their costs comparatively low are concentrated in a fairly small number of U.S. counties. In the 25 counties where the cost differences between MA plans and traditional Medicare are largest, MA plans spent a total of $5.2 billion less than what traditional Medicare would have been expected to spend on the same beneficiaries, with health maintenance organizations (HMOs) accounting for all of that difference. In the rest of the country, MA plans spent $4.8 billion above the expected costs under traditional Medicare. Broad determinations about the relative efficiency of MA plans and traditional Medicare can therefore be misleading, as they fail to take into account local conditions and individual plans' performance.
平均而言，为参加私人医疗保险优势（MA）计划的参保人提供福利的成本略低于传统医疗保险在同一县为每位受益人支出的费用。然而，能够将成本保持在相对较低水平的MA计划集中在美国少数几个县。在MA计划与传统医疗保险成本差异最大的25个县，MA计划的总支出比传统医疗保险预计在相同受益人身上的支出少52亿美元，其中健康维护组织（HMO）占了所有这些差异。在该国其他地区，MA计划的支出比传统医疗保险预期成本高出48亿美元。因此，关于MA计划和传统医疗保险相对效率的广泛判断可能会产生误导，因为它们没有考虑当地情况和个别计划的表现。
