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Medicare (Dis)Advantage?

Medicare (Dis)Advantage? Beneficiaries who enroll in Medicare Advantage private fee-for-service (PFFS) plans can face significant financial risks, said the Government Accountability Office (GAO) in a report. Medicare Advantage, an alternative to the original Medicare fee-for-service program, allows a variety of private plans, including PFFS plans, to provide Medicare benefits to enrollees. Medicare Advantage enrollment has grown from about 4.7 million beneficiaries in June 2004 to 9.6 million in June 2008, with 45% of this enrollment growth occurring in PFFS plans. The December 15 report (http://www.gao.gov/new.items/d0925.pdf) said some PFFS plans charged cost-sharing fees that could be substantial and designed elaborate prenotification hurdles, leaving beneficiaries with higher costs than they would expect. Perhaps not surprisingly, from January through April 2007, about 21% of beneficiaries disenrolled from the PFFS plans; disenrollment ran about 9% for other Medicare Advantage plans. The GAO report was prepared at the request of 5 House Democrats who suggested increased oversight or even elimination of the PFFS plans. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Medicare (Dis)Advantage?

Mitka, Mike
JAMA , Volume 301 (6) – Feb 11, 2009
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Medicare (Dis)Advantage?

Abstract

Beneficiaries who enroll in Medicare Advantage private fee-for-service (PFFS) plans can face significant financial risks, said the Government Accountability Office (GAO) in a report. Medicare Advantage, an alternative to the original Medicare fee-for-service program, allows a variety of private plans, including PFFS plans, to provide Medicare benefits to enrollees. Medicare Advantage enrollment has grown from about 4.7 million beneficiaries in June 2004 to 9.6 million in June 2008, with 45%...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2009.86
Publisher site
See Article on Publisher Site

Abstract

Beneficiaries who enroll in Medicare Advantage private fee-for-service (PFFS) plans can face significant financial risks, said the Government Accountability Office (GAO) in a report. Medicare Advantage, an alternative to the original Medicare fee-for-service program, allows a variety of private plans, including PFFS plans, to provide Medicare benefits to enrollees. Medicare Advantage enrollment has grown from about 4.7 million beneficiaries in June 2004 to 9.6 million in June 2008, with 45% of this enrollment growth occurring in PFFS plans. The December 15 report (http://www.gao.gov/new.items/d0925.pdf) said some PFFS plans charged cost-sharing fees that could be substantial and designed elaborate prenotification hurdles, leaving beneficiaries with higher costs than they would expect. Perhaps not surprisingly, from January through April 2007, about 21% of beneficiaries disenrolled from the PFFS plans; disenrollment ran about 9% for other Medicare Advantage plans. The GAO report was prepared at the request of 5 House Democrats who suggested increased oversight or even elimination of the PFFS plans.

Journal

JAMA – American Medical Association

Published: Feb 11, 2009

Keywords: medicare

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