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降低医疗保险优势基准将降低计划的慷慨程度,但这些影响可能不大。

Reducing Medicare Advantage Benchmarks Will Decrease Plan Generosity, But Those Effects Will Likely Be Modest.

作者信息

Chernew Michael E, Miller Keaton, Petrin Amil, Town Robert J

机构信息

Michael E. Chernew (

Keaton Miller, University of Oregon, Eugene, Oregon.

出版信息

Health Aff (Millwood). 2023 Apr;42(4):479-487. doi: 10.1377/hlthaff.2022.01031. Epub 2023 Mar 22.

Abstract

Concerns that Medicare Advantage (MA) plans are overpaid have motivated calls to reduce MA benchmarks-the dollar amounts set by the Centers for Medicare and Medicaid Services (CMS) against which MA plans bid to set premiums and fund extra benefits. However, cutting benchmarks may lead to higher MA enrollee premiums and decreased plan generosity. We assessed the relationships between MA benchmarks and plan generosity and benefits. We estimated that a $1,000 per year decrease in benchmarks would lead to small increases in annual premiums of about $60 and increases in annual deductibles of about $27. Copays would also increase modestly, and the propensity to offer benefits would generally decline by less than 5 percentage points, with the greatest impact being on the availability of dental, hearing, and vision benefits. These results suggest that although cuts to MA benchmarks would adversely affect plan generosity, those effects would be modest.

摘要

对医疗保险优势(MA)计划支付过高的担忧促使人们呼吁降低MA基准——医疗保险和医疗补助服务中心(CMS)设定的美元金额,MA计划据此投标以设定保费并为额外福利提供资金。然而,削减基准可能会导致MA参保人的保费增加,计划慷慨程度降低。我们评估了MA基准与计划慷慨程度和福利之间的关系。我们估计,基准每年减少1000美元将导致年度保费小幅增加约60美元,年度免赔额增加约27美元。共付额也会适度增加,提供福利的倾向通常会下降不到5个百分点,对牙科、听力和视力福利的可获得性影响最大。这些结果表明,尽管削减MA基准会对计划慷慨程度产生不利影响,但这些影响将是适度的。

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