scholarly journals Enrolee outcomes after health insurance plan terminations: a diagnosis of default effects

2018 ◽  
Vol 2 (1) ◽  
pp. 56-77
Author(s):  
ANNA D. SINAIKO ◽  
RICHARD ZECKHAUSER
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Drug Coverage ◽  
Economic Research ◽  
Status Quo Bias ◽  
Revealed Preferences ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Insurance Plan ◽  
Large Numbers

AbstractBehavioural economic research has established that defaults, one form of nudge, powerfully influence choices. In most policy contexts, all individuals receive the same nudge. We present a model that analyses the optimal universal nudge for a situation in which individuals differ in their preferences and hence should make different choices and may incur a cost for resisting a nudge. Our empirical focus is onterminated choosers(TCs), individuals whose prior choices become no longer available. Specifically, we examine the power of defaults on individuals who had enrolled in Medicare Advantage plans with drug coverage and whose plans were then discontinued. Currently, if these TCs fail to actively choose another Medicare Advantage plan, they are defaulted into traditional fee-for-service Medicare (TM) without drug coverage. Overall, the rate of transition of TCs into TM is low, implying that original preferences and status quo bias overpower the default. Increasing numbers of Americans are choosing plans in health insurance exchange settings such as Medicare, the Affordable Care Act and private exchanges. Plan exits and large numbers of TCs are inevitable, along with other forms of turmoil. Any guidance and defaults provided for TCs should factor in their past revealed preferences.

Effect of Utilization Review in a Fee-for-Service Health Insurance Plan

1995 ◽  
Vol 333 (20) ◽  
pp. 1326-1331 ◽  
Author(s):  
Stephen N. Rosenberg ◽  
David R. Allen ◽  
Janis S. Handte ◽  
Thomas C. Jackson ◽  
Leonard Leto ◽  
...  
Keyword(s):  
Health Insurance ◽  
Utilization Review ◽  
Fee For Service ◽  
Insurance Plan ◽  
Health Insurance Plan

Prices for Physicians’ Services in Medicare Advantage and Commercial Plans

2018 ◽  
Vol 77 (3) ◽  
pp. 236-248 ◽  
Author(s):  
Daria M. Pelech
Keyword(s):  
Health Insurance ◽  
Claims Data ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Physician Services ◽  
Insurance Premiums ◽  
Health Insurance Premiums

The prices that insurers pay physicians ultimately affect beneficiaries’ health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare’s fee-for-service (FFS) program would pay for the same service. MA prices paid by those insurers were close to Medicare FFS prices, varied minimally, and were similar in and out of network. In contrast, commercial prices paid by the same insurers were substantially higher than FFS, varied widely, and were up to three times higher out of network than in network. Those results suggest that insurers can use statutory limits on out-of-network charges in MA to negotiate lower in-network prices in those plans. In contrast, without those limits on out-of-network prices, in-network prices in commercial plans are much higher.

scholarly journals The Relationship between Health Insurance and Mortality for Cancer Patients: Medicare Advantage versus Fee-For-Service Medicare

2019 ◽  
Vol 5 (3) ◽  
pp. p293
Author(s):  
Brett Lissenden
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Medical Providers ◽  
Part D ◽  
Key Innovation ◽  
The Relationship

Compared to traditional fee-for-service Medicare (FFS), private Medicare Advantage (MA) plans offer additional health insurance coverage but restrict access to medical providers. This study measured how MA enrollment, relative to FFS enrollment, may influence mortality for cancer patients. The study used linked data from the Surveillance, Epidemiology, and End Results Program and Medicare administration (SEER-Medicare) including diagnoses between 2006 and 2011 at all four major cancer sites (breast, colorectal, lung, prostate). The key innovation of the study was to measure and account for variation in prescription drug coverage between MA and FFS cancer patients. Among cancer patients with Part D coverage, MA enrollment was associated with modestly increased mortality. The estimated relationships were statistically distinguishable from zero for lung cancer and (in most model specifications) colorectal cancer. The findings are consistent with a hypothesis that restricted provider access may reduce health outcomes for patients who already have a serious illness.

scholarly journals Do Insurers Compete on the Federal Health Insurance Exchange?

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 25
Author(s):  
Jesse N. Cohen ◽  
Alexander Coppock ◽  
Arnab K. Ghosh ◽  
Benjamin P. Geisler
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Early Stage ◽  
Cross Sectional Study ◽  
Insurance Plan ◽  
Cross Sectional ◽  
Data Set ◽  
Insurance Premiums ◽  
The Relationship ◽  
Early Market

Background: On the U.S. Federal Health Insurance Exchange established by the Affordable Care Act, states with fewer insurers have higher insurance premiums than states with more insurers. This expected feature of a competitive market has not been studied within states, however. We tested the hypothesis that insurance premiums decrease in more competitive geographic rating areas within states in the U.S.A.Methodology/principle findings: This cross-sectional study utilized publicly available premiums from the Federal Health Insurance Exchange website, www.healthcare.gov. Univariate and multivariate analyses were used to model premiums based on the number of insurers in geographic rating areas. The relationship between premiums and the number of insurers competing in a geographic rating area was also calculated for each unique insurance plan offered on the exchange. The data set and statistical code used for this research is linked in the publication. We found that there was an unexpected, marginally positive relationship between average monthly premiums and the number of insurers in a geographic rating area (+$5.71 in monthly premiums per additional insurer, p<0.001). We also found that identical plans tend to be offered with marginally higher premiums in rating areas with more insurers (+$3.18 in monthly premiums per additional insurer, p=0.002), contrary to the relationship we expected from a competitive marketplace. The principle limitation of the study is that this unexpected relationship, which suggests a lack of competitiveness of this early market, could be due to unobserved confounding factors that influence pricing in more competitive rating areas.Conclusion: On the Federal Health Insurance Exchange, the price of insurance is higher in more competitive rating areas within states. This may be explained by lack of competition in this early stage market.

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