The data contain the direct subsidy, reinsurance payments, and enrollee
risk scores for each plan.
About 81% of Medicare fee-for-service enrollees
now use some kind of public or private arrangement to cap their maximum out-of-pocket spending, and to cope with ordinary deductible, co-payment and coinsurance bills, according to GAO analysts.
For a new enrollee
with family income near the poverty level, this may be significant if the child has no immediate need for health care.
CMS should exercise its authority to address all of these issues by reiterating and reinforcing the rights of Medicaid enrollees
A comprehensive analysis of the un-duplication process is available in the report "Continuing Development of the Medicaid Analytic Extract Enrollee
Master (MAXEM) File" (Czajka, Wenzlow, & Sykes, 2010; Czajka & Verghese, 2011).
Key findings include that nearly one of every five Part D non-LIS enrollees
reached the coverage gap in 2009 and that among Part D non-LIS enrollees
who filled one or more prescriptions in 2009 about one in five had spending high enough to reach the coverage gap.
If all enrollee
characteristics were observed, including characteristics that health insurers usually observe (X) and those that are typically unobserved (Z), the utilization effect and the risk selection effects could be estimated in the following regression:
The problem with Medicare's method of financing physician services is that a fourth of the financing comes from monthly premiums paid by Medicare enrollees
. These premiums are even more regressive than the payroll tax.
The key areas to investigate are the number of hospitalizations allowed per year, the accreditation status of contracted hospitals, hospital fees not covered (private room, blood products, private duty nursing), and the dollar cost to the enrollee
It is appropriate when the enrollee
is given a choice between higher- and lower-cost options.
Under the plan's guidelines each enrollee
was required to choose a group practice affiliated with the plan and to choose a primary care physician (family physician, internist, pediatrician, or obstetrician-gynecologist) at or before the time of first utilization of care under the plan.
CMS uses a risk-adjustment program to try to even out the overall level of enrollee
health risk each Medicare Advantage plan issuer assumes.