Meiselbach Mark K, Anderson Andrew, Samuel Laura J, Thomas Kali S
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Johns Hopkins School of Nursing, Baltimore, Maryland.
JAMA Health Forum. 2025 Jun 7;6(6):e251215. doi: 10.1001/jamahealthforum.2025.1215.
In Medicare Advantage (MA), the private component of the Medicare program that enrolls more than half of beneficiaries, an increasing share of plans are offering Part B premium givebacks to pay for part or all of the at least $174.70 Part B monthly premium. Millions of dollars of Medicare expenditures are attributable to this benefit, yet little is known about its association with member enrollment or other plan characteristics.
To document trends and expenditures in MA Part B premium givebacks and examine their association with plan enrollment.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal difference-in-differences analysis compared MA plan enrollment before and after the offer of a Part B giveback among plans that offered the giveback vs plans that did not. January MA plan enrollment and characteristics data from 2018 through 2024 were included. Data were analyzed from May 2024 to February 2025.
Adoption of a Part B giveback.
Total plan enrollment.
A sample of 18 627 plan-years representing more than 130 million enrollee-years was included in the analysis. The percentage of MA plans offering a Part B premium giveback increased from 4.3% (93 of 2187) in 2018 to 18.7% (737 of 3940) in 2024. Plans offering Part B premium givebacks had lower median enrollment, belonged to newer, higher rated contracts, had higher cost-sharing, and had lower enrollee risk scores compared with plans that did not offer givebacks. In 2024, the 3.4 million enrollees in plans with Part B givebacks received a mean (SD) of $77 ($42), amounting to as much as approximately $261 million in total monthly expenditures across the MA program. Adoption of a Part B giveback was associated with a 33.3% (95% CI, 9.3-56.9) increase in enrollment, robust to all model specifications. There was a dose-response association between the size of the giveback and enrollment.
In this study, the adoption of Part B premium givebacks among MA plans was associated with a substantial increase in plan enrollment. Further research will be needed to understand the total value to enrollees of Part B givebacks, which confers hundreds of millions of dollars monthly to Medicare beneficiaries.
在医疗保险优势计划（MA）中，这是医疗保险计划的私人组成部分，参保人数超过半数受益人，越来越多的计划开始提供B部分保费返还，以支付每月至少174.70美元的B部分保费的一部分或全部。数以百万计的医疗保险支出归因于这项福利，但对于其与会员参保情况或其他计划特征之间的关联却知之甚少。
记录MA中B部分保费返还的趋势和支出情况，并研究它们与计划参保情况的关联。
设计、设置和参与者：这项纵向差异分析比较了提供B部分保费返还的计划与未提供该返还的计划在提供返还前后的MA计划参保情况。纳入了2018年至2024年1月的MA计划参保情况和特征数据。数据于2024年5月至2025年2月进行分析。
采用B部分保费返还。
计划总参保人数。
分析纳入了18627个计划年度的样本，代表超过1.3亿参保人年度。提供B部分保费返还的MA计划的百分比从2018年的4.3%（2187个中的93个）增至2024年的18.7%（3940个中的737个）。与未提供返还的计划相比，提供B部分保费返还的计划参保人数中位数较低，属于更新的、评级更高的合同，成本分摊更高，参保人的风险得分更低。2024年，参与有B部分保费返还计划的340万参保人平均（标准差）获得了77美元（42美元）的返还，整个MA计划每月总支出高达约2.61亿美元。采用B部分保费返还与参保人数增加33.3%（95%置信区间，9.3 - 56.9）相关，在所有模型设定下均稳健。返还规模与参保人数之间存在剂量反应关联。
在本研究中，MA计划中采用B部分保费返还与计划参保人数大幅增加相关。需要进一步研究以了解B部分保费返还对参保人的总价值，这每月为医疗保险受益人带来数亿美元的收益。
