This is the monthly reinsurance payment to the plan for an average-risk enrollee
(risk = 1.0) in the given year.
If the Medicare fee-for-service program offered enrollees
the kind of annual out-of-pocket spending cap that Affordable Care Act-compliant private major medical plans now provide, "the addition of an annual cap would reduce the need of some beneficiaries to purchase supplemental insurance," James Cosgrove, a GAO director, writes in a new GAO report.
This study investigates whether new enrollees
in the Alabama Children's Health Insurance Program have different claims experience from renewing enrollees
who do not have a lapse in coverage and from continuing enrollees
For example, enrollees
' confidentiality is often breached inadvertently by health plans through explanation of benefits letters and other communications about services, billing and benefits (see "A New Frontier in the Era of Health Reform: Protecting Confidentiality for Individuals Insured as Dependents," Fall 2013).
We examined the number of moves per enrollee
, and the number of states to which an enrollee
moved, to determine if a greater number of moves, or moves to more states, increased the length of enrollment gaps.
In a previous report using 2007 data we found that many people--26% of Part D non-LIS enrollees
, or 15% of Part D enrollees
overall--reached the coverage gap," explains the study.
characteristics Z are typically unobserved, separately identifying the utilization and risk selection effects from Equation (1) is not possible if unobserved characteristics are correlated with both medical resource use and health plan choice.
In July 1997, the New England Journal of Medicine published a study comparing hospital utilization rates among HMO and FFS Medicare enrollees
in the year before the HMO enrollees
left FFS Medicare to join an HMO, and in the three months after some of the HMO enrollees
disenrolled and returned to FFS Medicare.
The emergency room consent for treatment typically includes a clause that requires direct payment by the enrollee
if the plan determines the visit was not medically necessary.
* Ask the insurance carrier for the average number of prescriptions per enrollee
preferences regarding clinic and physician are summarized in Table 5.
The oldest Medicare program, Medicare Part A, pays enrollees
' hospital bills.
Computer data matching problems caused nightmares for insurers trying to file 2014 and 2015 enrollee
data for the Affordable Care Act cost-sharing reduction subsidy program.
Second, we find that the enrollees
in the program tended to be not only older but also relatively sick, suggesting that the cost per enrollee
of the ACA expansions may be greater than expected.