Informing the Debate about Curbing Medicare Advantage Overpayments
End Notes
[1] Medicare Payment Advisory Commission, “Report to the Congress: Promoting Greater Efficiency in Medicare,” June 2007 and Peter Orszag, “The Medicare Advantage Program: Enrollment Trends and Budgetary Effects,” Testimony before the Senate Finance Committee, Congressional Budget Office, April 11, 2007.
[2] Brian Biles, Lauren Hersh Nicholas, Barbara Cooper, Emily Adrion and Stuart Guterman, “The Cost of Privatization: Extra Payments to Medicare Advantage Plans— Updated and Revised,” The Commonwealth Fund, November 2006. See also Brian Biles and Emily Adrion, “The Cost of Privatization: Extra Payments to Medicare Advantage Plans; Updated Tables for 2007,” George Washington University, May 1, 2007.
[3] America’s Health Insurance Plans, “AHIP Raises Concerns about New MedPAC Report and its Potential Impact on Beneficiaries,” March 1, 2007; Scott Serota, “Statement on MedPAC Report,” Blue Cross and Blue Shield Association; and Centers for Medicare and Medicaid Services, “Medicare Advantage in 2007,” April 20, 2007.
[4] Mary Agnes Carey, “Cuts to Medicare Private Fee-for-Service Plans Would Yield Modest Savings,” CQ Healthbeat News, June 28, 2007.
[5] Medicare Payment Advisory Commission, op cit.
[6] See Edwin Park and Robert Greenstein, “Private Plan Overpayments Weaken Medicare’s Financing and Hasten the Program’s Insolvency,” Center on Budget and Policy Priorities, April 20, 2007 (discussing testimony of Peter Orszag, CBO Director, before the Senate Finance Committee on April 11, 2007). See also Medicare Payment Advisory Commission, op cit.
[7] Peter Orszag, “The Medicare Advantage Program,” Testimony before the House Budget Committee, Congressional Budget Office, June 28, 2007.
[8] BNA Health Care Policy Daily, “CMS Actuary Says Medicare Funding Warning Likely Not Needed if Managed Care Pay Cut,” April 26, 2007.
[9] BNA Health Care Policy Daily, “Growth of Managed Care Plans Threaten Program’s Finances, MedPAC Chairman Says,” March 2, 2007.
[10] Glenn Hackbarth, “The Medicare Advantage Program and MedPAC Recommendations,” Testimony before the Senate Finance Committee, Medicare Payment Advisory Commission, April 11, 2007 and BNA Health Care Policy Daily, “CMS Actuary Says Medicare Funding Warning Likely Not Needed if Managed Care Pay Cut,” April 26, 2007.
[11] See, for example, Karen Ignagni, Testimony before the Senate Finance Committee, American Association of Health Plans, May 27, 1999.
[12] See, for example, June Gibbs Brown, “Adequacy of Medicare’s Managed Care Payments After the Balanced Budget Act of 1997,” Office of Inspector General, U.S. Department of Health and Human Services, September 18, 2000; General Accounting Office, “Medicare Managed Care: HMO Rates, Other Factors Create Uneven Availability of Benefits, May 1997; and General Accounting Office, “Medicare Managed Care: Growing Enrollment Adds Urgency to Fixing HMO Payment Problem,” November 1995.
[13] Medicare Payment Advisory Commission, “Report to the Congress: Promoting Greater Efficiency in Medicare,” op cit.
[14] Thomas Rice and Katherine Desmond, “The Distributional Consequences of a Medicare Premium Support Proposal,” Journal of Health Politics, Policy, and Law, December 2004 and Congressional Budget Office, “Designing a Premium Support System for Medicare,” December 2006.
[15] See, for example, Brian Biles, Lauren Hersch Nicholas and Stuart Guterman, “Medicare Beneficiary Out-of-Pocket Costs: Are Medicare Advantage Plans a Better Deal?” The Commonwealth Fund, May 2006.
[16] While Medicare generally prohibits Medicare Advantage plans from discriminating on the basis of health status, an analysis by the Commonwealth Fund found that that “compliance with this broad policy is not carefully defined and enforced by CMS....” Biles et al., op cit.
[17] Medicare Rights Center, “Too Good to Be True: The Fine Print in Medicare Private Health Plan Benefits,” April 2007; Biles et al., op cit; Medicare Payment Advisory Commission, “Report to the Congress: Benefit Design and Cost Sharing in Medicare Advantage Plans,” December 2004; and Patricia Neuman, “Medicare Advantage: Key Issues and Implications for Beneficiaries,” Testimony before the House Budget Committee, Kaiser Family Foundation, June 28, 2007.
[18] Centers for Medicare and Medicaid Services, “2008 Call Letter,” April 19, 2007.
[19] See, for example, America’s Health Insurance Plans, “Low-Income and Minority Beneficiaries in Medicare Advantage Plans,” February 2007.
[20] See Edwin Park and Robert Greenstein, “Low-Income and Minority Beneficiaries Do Not Rely Disproportionately on Medicare Advantage Plans,” Center on Budget and Policy Priorities, Revised April 12, 2007.
[21] Park and Greenstein, op cit.
[22] Neuman, op cit and Park and Greenstein, op cit.
[23] Mark Miller, “The Medicare Advantage Program and MedPAC Recommendations,” Testimony before the House Budget Committee,” Medicare Payment Advisory Commission, June 28, 2007 and Glenn Hackbarth, Oral Testimony before the Senate Finance Committee, April 11, 2007.
[24] The three programs are the Qualified Medicare Beneficiary program (QMB), the Specified Low-Income Medicare Beneficiary program (SLMB), and the Qualifying Individual program (QI-1). QMB pays all Medicare premiums and cost-sharing for poor beneficiaries; the other two programs pay Medicare premiums (but not cost-sharing) for beneficiaries with incomes up to 135 percent of the poverty line
[25] Miller, op cit. The Medicare Part D drug benefit includes a separate subsidy for low-income Medicare beneficiaries that pays for Part D premiums and/or Part D deductibles and cost-sharing.
[26] In 2004, 24 percent of Medicare beneficiaries lived in rural areas. See Kaiser Family Foundation, “Medicare Chartbook,” July 2005.
[27] Timothy McBridge, Tanchica Terry and Keith Mueller, “Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for-Service Plans,” RUPRI Center for Rural Health Policy Analysis, April 2007.
[28] Medicare Payment Advisory Commission, “Report to the Congress: Medicare Payment Policy,” March 2007.
[29] Medicare Payment Advisory Commission, “Issues in a Modernized Medicare Program,” June 2005.
[30] See, for example, Medicare Payment Advisory Commission, “Promoting Great Efficiency in Medicare,” op cit.
[31] Peter Orszag, “The Medicare Advantage Program,” op cit.
[32] See, for example, Robert Pear, “Hard Sell Cited as Insurers Push Plans to Elderly,” New York Times, May 7, 2007; Victoria Colliver, “Medicare plans under scrutiny: Complaints are adding up from seniors upset with private health care packages,” San Francisco Chronicle, January 26, 2007; and Milt Freudenheim, “Luring Customers from Medicare,” New York Times, September 22, 2006.
[33] See David Lipschutz, Paul Precht, and Bonnie Burns, “After the Goldrush: The Marketing of Medicare Advantage and Part D Plans,” California Health Advocates and the Medicare Rights Center, January 2007.
[34] Sean Dilweg, Wisconsin Insurance Commissioner, “Testimony of Sean Dilweg, Wisconsin Insurance Commissioner, before the United States Special Committee on Aging Regarding Medicare Advantage Marketing and Sales,” Testimony before the Senate Special Committee on Aging, May 16, 2007. See also Kim Holland, Oklahoma Insurance Commissioner, “Senate Special Committee on Aging Testimony for 5/16/07,” Testimony before the Senate Special Committee on Aging, May 16, 2007 and Sherry Mowell, “Remarks before the Senate Committee on Aging: Sherry Mowell, Special Agent, Georgia Insurance and Safety Fire Commissioner John Oxendine,” Testimony before the Senate Special Committee on Aging, May 16, 2007.
[35] Until CMS and the Medicare Advantage plans offering private fee-for-service plans voluntarily suspended the marketing of such plans in June 2007, there had been little effort by CMS to rein in marketing abuses by private plans and their agents. See Holland, op cit and Lipschutz, Precht and Burns, op cit.
[36] Jim Hahn, “Standardized Choices: Medigap Lessons for Medicare Part D,” Congressional Research Service, March 8, 2006.
[37] “Report on Marketing and Abuse and Administrative Problems Involving the Health Insurance Component of the Earned Income Tax Credit,” Subcommittee on Oversight of the House Ways and Means Committee, June 1, 1993.