Guterman Stuart, Skopec Laura, Zuckerman Stephen
Health Policy Center, Urban Institute.
Issue Brief (Commonw Fund). 2018 Mar 1;2018:1-11.
Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare.
Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased.
Analysis of Medicare data on MA plan bids, net of rebates.
While spending per beneficiary in traditional Medicare rose 5.0 percent between 2009 and 2014, MA payment benchmarks rose 1.5 percent and payment to plans decreased by 0.7 percent. Plans' expected per enrollee costs grew 2.6 percent. Plans where payment rates decreased generally had slower growth in their expected costs. HMOs, which saw their payments decline the most, had the slowest expected cost growth.
In general, MA plans responded to lower payment by containing costs. By preserving most of the margin between Medicare payments and their bids in the form of rebates, they could continue to offer additional benefits to attract enrollees. The magnitude of this response varied by geographic area and plan type. Despite this slower growth in expected per enrollee costs, greater efficiencies by MA plans may still be achievable.
自2009年以来，医疗保险优势（MA）计划的参保人数显著增加，尽管立法降低了医疗保险向这些计划支付的参保人护理费用。目前，MA计划的支付平均已接近传统医疗保险的成本水平。
研究2009年至2014年期间每位参保人的成本变化，以更好地了解MA计划在支付减少的情况下仍能持续蓬勃发展的原因。
分析医疗保险关于MA计划投标（扣除回扣）的数据。
2009年至2014年期间，传统医疗保险中每位受益人的支出增长了5.0%，而MA计划的支付基准增长了1.5%，向计划的支付减少了0.7%。计划的预期每位参保人成本增长了2.6%。支付率下降的计划，其预期成本增长通常较慢。支付下降幅度最大的健康维护组织（HMO），其预期成本增长最慢。
总体而言，MA计划通过控制成本来应对支付减少的情况。通过以回扣的形式保留医疗保险支付与其投标之间的大部分利润空间，它们可以继续提供额外福利以吸引参保人。这种应对措施的程度因地理区域和计划类型而异。尽管每位参保人的预期成本增长较为缓慢，但MA计划仍有可能实现更高的效率。
