Marquette University College of Nursing, Milwaukee, WI, USA.
Inquiry. 2022 Jan-Dec;59:469580221094469. doi: 10.1177/00469580221094469.
Health insurance coverage options are complicated and often leave Medicare beneficiaries, families, advocates, and brokers confused. Medicare should make small changes to its existing "Compare Coverage Options" tool that would enhance the public's understanding of the trade-offs between Medicare Advantage and supplemental Medigap with Fee-for-Service Medicare. For cost considerations, Medicare should include a projection of annual out-of-pocket (OOP) spending, whether an OOP cap applies and whether the ability to alter OOP for additional clinical benefit is offered. For access considerations, Medicare should provide access to information to educate the public on coverage and costs associated with dental, vision, and hearing benefits, network adequacy, prior authorization, and supplemental benefits. These changes will enhance transparency and decision making.
健康保险覆盖范围选项复杂，常常使医疗保险受益人、家庭、拥护者和经纪人感到困惑。医疗保险应该对其现有的“比较覆盖范围选项”工具进行小的修改，以增强公众对医疗保险优势和补充性医疗保险与服务付费医疗保险之间权衡的理解。出于成本考虑，医疗保险应包括年度自付费用（OOP）支出的预测，是否适用 OOP 上限，以及是否提供增加 OOP 以获得额外临床效益的能力。出于获得服务的考虑，医疗保险应提供有关与牙科、视力和听力福利、网络充足性、事先授权和补充福利相关的覆盖范围和成本的信息，以教育公众。这些变化将提高透明度和决策能力。
