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.
Since
enrollee 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 per year.
Other
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.
