Medicare Advantage: Quality Bonus Payment Demonstration Undermined by High Estimated Costs and Design Shortcomings

摘要

The Medicare Advantage (MA) program, an alternative to the original Medicare fee-for-service (FFS) program, provides health care coverage to Medicare beneficiaries through private health plans offered by organizations under contract with the Centers for Medicare & Medicaid Services (CMS). In 2011, about a quarter of all Medicare beneficiaries were enrolled in approximately 3,300 MA plans sponsored by 175 MA organizations. These organizations generally offer beneficiaries one or more plans to choose from--with different coverage, premiums, and cost sharing features--in the areas they serve. Also, MA plans may provide additional benefits not offered under Medicare FFS, such as reduced cost sharing or vision and dental care coverage. In 2010, Medicare payments to MA plans totaled about $115 billion, or roughly 25 percent of all Medicare spending for Part A and Part B.