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June 06, 2010 at 08:00 PM
WASHINGTON–Medicare Advantage plans with relatively low premiums and high levels of cost-sharing ended up with healthier enrollees in 2008 than did other Medicare Advantage plans, the U.S. Government Accountability Office says.
Officials at the GAO have published figures supporting that finding in a summary of results from an analysis of data from 2,899 plans that enrolled 7.5 million Medicare beneficiaries in 2008.
The private organizations that run Medicare Advantage plans are supposed to avoid using premium rates, plan features, or other underwriting techniques to “cherry pick,” or attract healthier enrollees and repel enrollees with health problems.
“We did not determine whether [Medicare Advantage organizations] structured their plan benefit packages in response to enrolled beneficiaries’ health status or whether beneficiaries of a given health status chose certain MA plans specifically because of their benefit package designs,” James Cosgrove, a GAO director, writes in a letter summarizing the GAO findings.
But, whether intended or not, plans with certain kinds of designs ended up attracting significant healthier enrollees than did other plans, Cosgrove writes.
GAO divided MA plans into three groups: Good-health plans, in which the members’ average projected health care costs were 10% lower than average; poor-health plans, in which projected health care costs were 10% higher than average; and average-health plans, with projected costs somewhere in the middle.
About 43% of the plans were in the good-health group, 37% in the average-health group and 20% in the poor-health group.
When GAO analysts looked at the enrollees, they found that 29% were in plans in the good-health group, 55% in plans in the average-health group, and 16% in plans in the poor-health group.
