In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the program, and monthly premiums and cost sharing rose in the remaining plans. In anticipation of an expanded role for private plans in 2006, the Medicare Modernization Act attempted to stabilize the...

Reviews TennCare's behavioral health carve-out program, as well as how TennCare's structure affects the disabled and chronically ill, noting the importance of establishing a system for tracking quality and access from the start.

Reviews the early effects of the Benefits Improvement and Protection Act, which raised payment rates as of March 2001. Notes that only a few plans re-entered but those that did had important roles in their markets. As time goes on, effects are more likely to be seen in urban areas, since the...

The Affordable Care Act has altered payment policy for private Medicare Advantage (MA) plans, with the goal of lowering costs to bring them closer to the costs of traditional Medicare. Using new information on 2009 MA costs, an issue brief compares plans’ estimates of per capita costs for...

This brief summarizes issues discussed at a recent roundtable on Medicaid risk-based managed care, convened by the Kaiser Commission on Medicaid and the Uninsured and moderated by senior fellow Marsha Gold. Topics covered included provider networks, care delivery, and payment arrangements;...

Physician participation in Medi-Cal is problematic. A 1999 statewide survey of beneficiaries showed 56 percent reported difficulty finding physicians willing to see them, and a 1998 survey of California physicians found that nearly half do not accept Medi-Cal patients. Low participation levels...

This fact sheet, the first in a series from Mathematica's study of the insurance decisions made by Medicare beneficiaries, looks at enrollment and plan participation trends, availability of plan choices, and other factors.

This report offers a more detailed look at Medicare Advantage (MA) benefit structures and how they compare to standard Medigap options. MA plans simplify cost sharing for Medicare Part A and B benefits, with most plans eliminating inpatient day limits and shifting from deductibles and...