본문 내용으로 건더뛰기

KDI 경제정보센터

ENG
  • Economic

    Information

    and Education

    Center

최신자료
The Importance of Plan Design in Medicare Advantage
AEI
2024.05.07
Medicare Advantage (MA) plans can vary substantially from one another in terms of their coverage design and patient out-of-pocket cost exposure, such as in terms of premiums, co-insurance, co-pays, and deductibles. However, it’s not well understood how different plan design features affect who enrolls in a given MA plan, whether and how certain features may address socioeconomic-related health disparities, or how they impact a plan’s healthcare utilization.

We examine these questions leveraging data from Inovalon, which gives us visibility on a broad and representative set of MA plans. The data also allow us to rigorously estimate the causal impact of each plan on key outcomes, on an enrollment adjusted basis. This is because the data also has visibility on each beneficiary’s pre-Medicare outcomes, while they were under commercial coverage, which can aid causal estimation by providing a statistical baseline.

Examining the impact of plan coverage design, we specifically compare plans employing more versus less managed care: Health Maintenance Organizations (HMOs) vs. Preferred Provider Organizations (PPOs). We find that HMO plans have over 25% lower utilization than PPOs for the same population, indicating that managed care provisions can be a highly impactful plan design element and can substantially reduce costs.