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为被诊断患有癌症的医疗保险优势计划参保人提供额外时间以重新评估参保情况的影响。

The effect of providing Medicare Advantage enrollees diagnosed with cancer additional time to reassess enrollment.

作者信息

Achola-Kothari Emma M, Dusetzina Stacie B, Graves John A, Stevenson David G, Keohane Laura M

机构信息

Vanderbilt University School of Medicine, Department of Health Policy, Vanderbilt University, Nashville, TN 37203, United States.

Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, United States.

出版信息

Health Aff Sch. 2025 Jun 27;3(7):qxaf131. doi: 10.1093/haschl/qxaf131. eCollection 2025 Jul.

Abstract

INTRODUCTION

Beneficiaries enrolled in Medicare Advantage (MA) and newly diagnosed with cancer may be incentivized to switch coverage, particularly if their MA plan restricts their access to cancer care. Beginning January 2019, the deadline to disenroll from an MA plan changed from February 14 to March 31 and, for the first time, beneficiaries could switch to a different MA plan as opposed to having to enter traditional Medicare.

METHODS

We used 2016-2019 Surveillance, Epidemiology, and End Results (SEER) Medicare data to conduct a difference-in-differences analysis, estimating the effect of this new policy on rates of MA plan switching 1 month and 2 months after diagnosis.

RESULTS

For beneficiaries diagnosed with cancer in March, the policy was associated with a modest increase in both overall rates of switching and in switching to a new MA plan 1 month after diagnosis. Results indicated that the policy had a modest positive effect on changes in Medicare coverage for enrollees diagnosed in January when outcomes were measured 2 months after diagnosis.

CONCLUSION

Relaxing enrollment rules for MA enrollees may not exacerbate adverse selection into traditional Medicare, given this evidence that beneficiaries with high-cost new diagnoses rarely exercised the option to change their MA plan.

摘要

引言

参加医疗保险优势计划(MA)且新确诊患有癌症的受益人可能会受到激励而更换保险覆盖范围,特别是如果他们的MA计划限制了他们获得癌症护理的机会。从2019年1月开始,从MA计划中退出的截止日期从2月14日改为3月31日,并且受益人首次可以转而选择不同的MA计划,而不必加入传统医疗保险。

方法

我们使用2016 - 2019年监测、流行病学和最终结果(SEER)医疗保险数据进行了双重差分分析,估计了这项新政策对确诊后1个月和2个月时MA计划转换率的影响。

结果

对于3月份被诊断患有癌症的受益人,该政策与确诊后1个月时总体转换率以及转而选择新MA计划的转换率适度增加有关。结果表明,当在确诊后2个月测量结果时,该政策对1月份确诊的参保人的医疗保险覆盖范围变化有适度的积极影响。

结论

鉴于有证据表明患有高成本新诊断疾病的受益人很少行使更改其MA计划的选择权,放宽MA参保人的参保规则可能不会加剧向传统医疗保险的逆向选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f77/12248418/67ed77437b33/qxaf131f1.jpg

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