Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics.

摘要

As a result of the changes that were established by the MMA and went into effect in 2005, the MA program experienced significant growth in rural areas, an area where enrollment was previously limited. In particular, through 2008, PFFS plans saw a significant increase in rural enrollment. Enrollment in MA plans in rural areas in December 2005 was 346,000 beneficiaries, with a total of 63,000 beneficiaries in PFFS plans. Over a period of three years, enrollment in rural areas tripled, increasing to over 1.2 million MA enrollees, with over 700,000 enrolled in PFFS plans. PFFS plans (versus other types of plan coverage options) were appealing to insurers wanting to offer MA coverage in rural areas since little overhead was necessary to enter the market, including the expense of negotiating with dominant providers to convince them to accept payment as part of a panel of providers. As established through legislation, PFFS plans were not required to create provider networks within their plans, which simplified the process and eased the costs associated with offering coverage; historically, PFFS plans are the only type of private Medicare plan not required to form provider networks. In addition, PFFS plans were paid at a higher payment rate than the average MA plan. For example, in 2008, estimates show that PFFS plans were paid on average 117% of traditional Medicare FFS costs, while the average among MA plans was 113% of FFS costs.