Why Medicare Advantage Plans Pay Hospitals Traditional Medicare Prices
- 1 August 2015
- journal article
- Published by Health Affairs (Project Hope) in Health Affairs
- Vol. 34 (8), 1289-1295
- https://doi.org/10.1377/hlthaff.2014.1427
Abstract
The policy community generally has assumed Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. After surveying senior hospital and health plan executives, we found, however, that MA plans nominally pay only 100–105 percent of traditional Medicare rates and, in real economic terms, possibly less. Respondents broadly identified three primary reasons for near–payment equivalence: statutory and regulatory provisions that limit out-of-network payments to traditional Medicare rates, de facto budget constraints that MA plans face because of the need to compete with traditional Medicare and other MA plans, and a market equilibrium that permits relatively lower MA rates as long as commercial rates remain well above the traditional Medicare rates. We explored a number of policy implications not only for the MA program but also for the problem of high and variable hospital prices in commercial insurance markets.Keywords
This publication has 4 references indexed in Scilit:
- How to Think Clearly About Medicare Administrative Costs: Data Sources and MeasurementJournal of Health Politics, Policy and Law, 2013
- The Growing Power Of Some Providers To Win Steep Payment Increases From Insurers Suggests Policy Remedies May Be NeededHealth Affairs, 2012
- An Economic History of Medicare Part CThe Milbank Quarterly, 2011
- Medicare Disadvantaged And The Search For The Elusive ‘Level Playing Field’Health Affairs, 2004