Risk adjustment as a tool to improve solidarity and incentives for cost containment under consumer cost sharing
|
|
- Elvin Brooks
- 7 years ago
- Views:
Transcription
1 Risk adjustment as a tool to improve solidarity and incentives for cost containment under consumer cost sharing Richard van Kleef Second Health Policy Workshop November 9, 2011
2 Outline Background: cost sharing in health plans Limitations of traditional forms of cost sharing Risk adjustment as a solution Empirical illustration Discussion NB: arguments and illustrations are from two recent publications: Kleef, R.C. van, W.P.M.M. van de Ven, and R.C.J.A. van Vliet. (2011/2012). Riskadjusting the doughnut-hole to improve efficiency and equity, Inquiry, forthcoming. Kleef, R.C. van, W.P.M.M. van de Ven and R.C.J.A. van Vliet. (2009). Shifted deductibles for high risks: more effective in reducing moral hazard than traditional deductibles, Journal of Health Economics, 28:
3 Background The responsiveness of the demand for medical care to net price is beyond doubt (Zweifel and Manning, HHE 2000) Natural experiments, observational comparisons of individuals, and the RAND-experiment have shown that insurance leads to an increase in the demand for medical care (i.e. moral hazard). Many health insurance plans worldwide include some form of consumer cost sharing to counteract moral hazard. RAND-experiment: in health plans with cost sharing the total medical expenses per person were substantially lower (up to 31%) than in health plans with full insurance coverage. A shortcoming of traditional forms of cost sharing, however, is that they do not take into account individual variation in health.
4 The concept of a deductible Up to a certain amount (d) consumers pay their medical expenses themselves before the insurer starts reimbursement. Simplified graphical illustration:
5 Limitations of deductibles Limitation 1: Expected out-of-pocket expenses will be higher for the chronically ill than for the healthy. Limitation 2: Incentives for cost containment will be weak for the chronically ill.
6 Explanation of limitation 2 Newhouse (1993, page 81) argues: Consider someone with a deductible of $1,000 who has to decide whether to visit his doctor for a market price of $40 on the first day of the contract period. If he would know for sure that his total expenses in the contract period will not exceed $1,000, the perceived price of the visit equals the market price. However, if he would know for sure that his total expenses will exceed $1,000 (i.e., if he would anticipate free care later in the contract period), the perceived price of the visit equals $0.
7 Illustration: data Administrative data from a Dutch insurer on total medical expenses (for inpatient care, outpatient care and pharmaceuticals among others) in 1994 (year t) and drug prescriptions in 1993 (year t-1) for about individuals Individuals were classified as being chronically ill if they had had at least 4 drug prescriptions in 1993, related to one of the following diseases: psychosis, mood disorders, COPD, inflammatory disorders, heart disease, thyroid disorders, high cholesterol, gout, peripheral artery disease, glaucoma, epilepsy, high blood pressure, diabetes, gastric disorders, inflammatory bowel disease, chronic pain, rheumatism, Parkinson's disease, cancer, cystic fibrosis
8 Table 1. Mean and standard deviation (S.D.) of expenses, by health category Health category based on drug prescriptions in year t-1 Prevalence in year t (%) Mean of expenses in year t (euros) S.D. of expenses in year t (euros) None of health problems below ,109 3,869 Psychosis ,468* 5,556 Mood disorders ,743* 4,654 COPD ,113* 5,819 Inflammations ,405* 5,768 Heart disease ,720* 6,795 Thyroid disorders ,042* 7,537 High cholesterol ,024* 6,173 Gout ,084* 6,772 Peripheral artery disease ,488* 5,688 Glaucoma ,761* 6,668 Epilepsy ,083* 9,040 High blood pressure ,676* 9,981 Diabetes ,175* 8,388 Gastric disorders ,842* 10,208 Inflammatory bowel disease ,056* 9,338 Chronic pains ,167* 7,097 Rheumatism ,366* 12,995 Parkinson's disease ,910* 17,427 Cancer ,441* 17,681 Cystic fibrosis ,593* 18,750 Total ,674 5,450 * Statistically significant from the group of individuals with none of the 20 health problems (p.001)
9 Applying a deductible of 500 euro
10 Table 2. Applying a deductible of 500 euro Health category based on drug prescriptions in year t-1 Probability of exceeding deductible in year t Expected out-of-pocket expenses in year t (euros) None of health problems below Psychosis 0.53* 377* Mood disorders 0.65* 418* COPD 0.65* 432* Inflammations 0.61* 400* Heart disease 0.61* 416* Thyroid disorders 0.61* 406* High cholesterol 0.86* 478* Gout 0.85* 475* Peripheral artery disease 0.70* 433* Glaucoma 0.69* 441* Epilepsy 0.71* 443* High blood pressure 0.83* 470* Diabetes 0.85* 473* Gastric disorders 0.90* 481* Inflammatory bowel disease 0.75* 442* Chronic pains 0.81* 457* Rheumatism 0.91* 485* Parkinson's disease 0.96* 497* Cancer 0.96* 492* Cystic fibrosis 0.94* 486* Total * Statistically significant from the group of individuals with none of the 20 health problems (p.001)
11 Doughnut hole as a solution? After reaching a certain level of medical expenses (s), consumers face a gap (d) in coverage. Simplified graphical illustration:
12 Applying a doughnut hole of 500 euro Starting at the mean of annual expenses
13 Table 3. Applying a doughnut hole of 500 euro starting at 1,674 euro Health category based on drug prescriptions in year t-1 Starting point Prob. of reaching DH Prob. of exceeding DH Expected out-ofpocket expenses None of health problems below 1, Psychosis 1, * 0.27* 162* Mood disorders 1, * 0.34* 197* COPD 1, * 0.34* 194* Inflammations 1, * 0.36* 201* Heart disease 1, * 0.33* 184* Thyroid disorders 1, * 0.39* 206* High cholesterol 1, * 0.47* 262* Gout 1, * 0.49* 267* Peripheral artery disease 1, * 0.45* 254* Glaucoma 1, * 0.40* 228* Epilepsy 1, * 0.43* 235* High blood pressure 1, * 0.49* 278* Diabetes 1, * 0.64* 344* Gastric disorders 1, * 0.68* 369* Inflammatory bowel disease 1, * 0.53* 290* Chronic pains 1, * 0.70* 370* Rheumatism 1, * 0.74* 391* Parkinson's disease 1, * 0.90* 454* Cancer 1, * 0.82* 440* Cystic fibrosis 1, * 0.78* 411* Total 1, * Statistically significant from the group of individuals with none of the 20 health problems (p.001)
14 Proposal: Risk-adjusted doughnut hole Let the starting point of the doughnut hole increase with the individual expected expenses. For healthy individuals with low expected expenses the doughnut hole starts at a relatively low expenditure level For the chronically ill with high expected expenses the doughnut hole starts at a relatively high expenditure level
15 Where to locate the doughnut hole? Raising the starting point reduces the probability of exceeding the doughnut hole and, thereby, increases incentives for cost containment in area [0, s+d] (= effect 1) However, raising the starting point also reduces the probability of reaching the doughnut hole and, thereby, reduces incentives for containment in area [0, s] (= effect 2) The challenge is to find the starting point at which the first effect no longer dominates the second. Probably this point is to be found somewhere in the center of the individual s expenditure distribution where the uncertainty about reaching/exceeding the doughnut hole is highest. In our illustration we locate the doughnut hole such that for each health category the individual expected out-of-pocket expenses equal 250 euro.
16 Table 4. Applying a doughnut hole of 500 euro with a risk-adjusted starting point Health category based on drug prescriptions in year t-1 Starting point Prob. of reaching DH Prob. of exceeding DH Expected out-ofpocket expenses None of health problems below Psychosis Mood disorders 1, COPD 1, Inflammations 1, Heart disease 1, Thyroid disorders 1, High cholesterol 1, Gout 1, Peripheral artery disease 1, Glaucoma 1, Epilepsy 1, High blood pressure 1, Diabetes 2, Gastric disorders 3, Inflammatory bowel disease 2, Chronic pains 3, Rheumatism 4, Parkinson's disease 5, Cancer 4, Cystic fibrosis 11, Total
17 Compared to traditional deductibles and doughnut holes, risk-adjusted doughnut holes can improve both solidarity and incentives for cost containment Of course, there are some important issues for further research / consideration
18 Issue 1: data and risk adjusters Individual-level data on medical expenses and risk characteristics must be available. Several criteria need to be taken into account when selecting appropriate risk adjusters, e.g. measurability, validity and no possibilities for manipulation. NB: In the Netherlands data and appropriate risk adjusters are already used for the purpose of risk equalization.
19 Issue 2: criterion for locating the DH In our example we located the doughnut hole such that the expected outof-pocket expenses were equal across health categories. This criterion does not necessarily maximize the incentives for cost containment. Theoretically, a better criterion to maximize incentives for cost containment is the variance in expected out-of-pocket expenses A drawback of this alternative, however, is its complexity and the fact that it does not necessarily lead to equal expected out-of-pocket expenses This implies that the choice for a criterion requires a trade-off among incentives for cost containment, solidarity and simplicity.
20 Issue 3: level of differentiation The health categories in our empirical illustration are probably heterogeneous in terms of expected expenses. This implies that further differentiation i.e. taking into account more risk characteristics might further improve solidarity and incentives for cost containment. At the same time, however, further differentiation will reduce the transparency of the health plan. This implies that the level of differentiation requires a trade-off between solidarity and incentives for cost containment on one hand and transparency on the other.
21 Issue 4: will consumers understand? To achieve incentives for cost containment it is crucial that consumers understand how the cost-sharing concept works. Hsu et al. (2008) have shown that beneficiaries who were aware that their plan included a doughnut hole were more likely to report any cost response compared to the complementary group. Hsu et al. (2008) have also shown that consumer knowledge about cost sharing does not come naturally. This implies that some education might be desirable. It might also be wise to start off simple, e.g. to distinguish between just two risk groups.
22 Issue 5: risk-adjusted coinsurance rate Table 1 shows a positive relationship between the expected value and variance of expenses. This implies that even with a risk-adjusted doughnut hole the chronically ill have a lower probability that their expenses in the contract period end up somewhere in/around the doughnut hole than the healthy This implies that an interesting extension to a risk-adjusted starting point might be a risk-adjusted coinsurance rate.
23 Table 4. Applying a doughnut hole of 500 euro with a risk-adjusted starting point Health category based on drug prescriptions in year t-1 Starting point Prob. of reaching DH Prob. of exceeding DH Expected out-ofpocket expenses None of health problems below Psychosis Mood disorders 1, COPD 1, Inflammations 1, Heart disease 1, Thyroid disorders 1, High cholesterol 1, Gout 1, Peripheral artery disease 1, Glaucoma 1, Epilepsy 1, High blood pressure 1, Diabetes 2, Gastric disorders 3, Inflammatory bowel disease 2, Chronic pains 3, Rheumatism 4, Parkinson's disease 5, Cancer 4, Cystic fibrosis 11, Total
24 Issue 6: potential cost savings? How large will be the extra cost savings when replacing traditional deductibles/doughnut holes with risk-adjusted doughnut holes? Van de Ven and Schut (TPE 2010) simulate that replacing a traditional deductible of 165 euro by a risk-adjusted doughnut hole of 165 euro in the Netherlands would substantially increase the reduction in moral hazard. Further research is needed to examine the relationship between price sensitivity and ex-ante probabilities of reaching/exceeding coverage gaps.
25 Conclusion Cost sharing can benefit from risk adjustment in terms of solidarity and incentives for cost containment. It might be desirable to start off simple, e.g. by distinguishing just two groups. When technical requirements have been met and consumers are familiar with the concept solidarity and incentives for cost containment can be further improved by more detailed risk adjustment.
How Can We Bend the Cost Curve? Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity
How Can We Bend the Cost Curve? Richard C. van Kleef Wynand P. M. M. van de Ven René C. J. A. van Vliet Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity An important goal of consumer cost-sharing
More informationRisk selection in a regulated health insurance market: a review of the concept, possibilities and effects
Risk selection in a regulated health insurance market: a review of the concept, possibilities and effects Expert Rev. Pharmacoecon. Outcomes Res. 13(6), 743 752 (2013) Richard C van Kleef*, Wynand PMM
More informationMedical Matters Action Checklists
Medical Matters Action Checklists The following Action Checklists are included in Chapter 5: Medical History Personal Medication Record Health Care Power of Attorney Medical Orders (Do Not Resuscitate/POLST)
More informationIncome and the demand for complementary health insurance in France. Bidénam Kambia-Chopin, Michel Grignon (McMaster University, Hamilton, Ontario)
Income and the demand for complementary health insurance in France Bidénam Kambia-Chopin, Michel Grignon (McMaster University, Hamilton, Ontario) Presentation Workshop IRDES, June 24-25 2010 The 2010 IRDES
More informationNATIONAL HEALTH FUND PRESENTATION
NATIONAL HEALTH FUND PRESENTATION WYNDHAM KINGSTON HOTEL KINGSTON JULY 28, 2012 TOPICS FOR PRESENTATION NHF - HISTORY - BENEFITS - APPLICATION - ENROLMENT JADEP - CONDITIONS COVERED NHFCARD - CONDITIONS
More informationGeneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America
More informationMedicare Part D Prescription Drug Coverage
Medicare Part D Prescription Drug Coverage Part 3 Version 7.1 August 1, 2013 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international
More informationMedicare Economics. Part A (Hospital Insurance) Funding
Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),
More informationUnderstanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act
Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Spring 2009 A b r i e f o v e r v i e w o f
More informationGROUP MEDICARE SUPPLEMENT PLANS. S5753_081213_GB03_MN Internal Approval 08/13/2013
2014 GROUP MEDICARE SUPPLEMENT PLANS S5753_081213_GB03_MN Internal Approval 08/13/2013 CREATE A HEALTHIER ORGANIZATION. Your employees are your organization s most valuable asset. As they retire, you want
More informationThe introduction of deductibles for prescription drugs in a national health insurance: compulsory or voluntary?
k~h-i pdiiy ELSEVIER Health Policy 31 (1995) 53-65 The introduction of deductibles for prescription drugs in a national health insurance: compulsory or voluntary? F.M. Bakker, R.C.J.A. van Vliet*, Department
More informationGROUP MEDICARE PLANS AT A GLANCE FOR EMPLOYER GROUPS. Toll-free 1-800-851-3379 ext. 8024 TTY: 711 HealthAlliance.org
GROUP MEDICARE PLANS GROUP MEDICARE PLANS AT A GLANCE FOR EMPLOYER GROUPS 2016 Toll-free 1-800-851-3379 ext. 8024 TTY: 711 HealthAlliance.org Coverage You Know and Trust If you ve worked with Health Alliance
More informationDual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?
Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid? Each month through our Helpline, PHLP talks to individuals (or to their family members, advocates or providers)
More informationUnderstanding Your Health
Understanding Your Health 2015 Objectives of Understanding Your Health After today s presentation, you will: Have a basic understanding of what is driving healthcare costs and how wellness and preventive
More informationMedicare part d, which offers
Trends The Effects Of The Coverage Gap On Drug Spending: A Closer Look At Medicare Part D Beneficiaries who entered the doughnut hole decreased their monthly prescriptions by about percent per month. by
More informationChapter 8: Just in Case Additional Material
Chapter 8: Just in Case Additional Material Here I go into detail about Medicare, Medicare Advantage (MA) plans, and Medigap plans. What about Medicare? Medicare is a federal health insurance program for
More information[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered
Incorporated Document (6) [COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered These charts show the benefits included in each
More informationAffordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion
Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation
More information2014 Summary of benefits plan comparison
2014 Summary of benefits plan comparison The tables below summarize the 2014 Benefits for the Samaritan Choice Medical Plan options (Basic, Wellness and High-Deductible Plans). Pease refer to your plan
More informationHow To Fill Out A Health Declaration
The English translation has no legal force and is provided to the customer for convenience only. The Dutch health declaration should be filled in. Health declaration for occupational disability insurance
More informationIf I have a psychiatric disability. Will Health Reform Help Me?
If I have a psychiatric disability Will Health Reform Help Me? For consumers of mental health services, a review of the bills passed by Congress in 2009 This paper was written by Chris Koyanagi, policy
More informationTHE A,B,C,D S OF MEDICARE
THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION
More informationTRENDS&ANALYSIS. What s the Best Value? Comparing Medicare HMOs and Supplemental Policies. March 2003
What s the Best Value? Comparing Medicare HMOs and Supplemental Policies Introduction Many California consumers seeking coverage beyond that provided by traditional Medicare have more than one option.
More informationMEDICARE: You ve earned It. Make the most of it.
Cigna Medicare Services MEDICARE: You ve earned It. Make the most of it. A simple guide filled with useful information on Medicare, health and wellness and more. Section 1 MEDICARE. PLAIN AND SIMPLE. Section
More informationHow To Get A Blue Cross Plan For Seniors
Medicare supplement plans Peace of mind from a name you trust Flexible plans backed by over 70 years of experience We ll be there for you Medicare supplement plans are designed to fill in the gaps that
More informationMedicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15
Medicare What you need to know Choose the plan that s right for you GNHH2ZTHH_15 Choosing a Medicare plan is a lot like buying a car. There are lots of options to consider. And what s right for you may
More informationLet s talk about Critical Illness insurance
Let s talk about Critical Illness insurance ivari can help you and your family keep the quality in quality of life should you be diagnosed with a critical illness. Critical illness insurance from ivari
More informationThe Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including
The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including charts, tables, and graphics may be difficult to read using
More informationPUBLIC HEALTH OPTOMETRY ECONOMICS. Kevin D. Frick, PhD
Chapter Overview PUBLIC HEALTH OPTOMETRY ECONOMICS Kevin D. Frick, PhD This chapter on public health optometry economics describes the positive and normative uses of economic science. The terms positive
More informationN Basic, including 100% Part B coinsurance. Basic including 100% Part B coinsurance* Basic including 100% Part B coinsurance
HEARTLAND NATIONAL LIFE INSURANCE COMPANY Outline of Medicare Supplement Coverage Benefit Plans A, D, F, G, M and N Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After Jun 1,
More informationAdvocare Essence (HMO-POS)
Advocare Essence (HMO-POS) offered by Security Health Plan of Wisconsin, Inc. You are currently enrolled as a member of Advocare Essence (HMO-POS). Next year there will be some changes to the plan s costs
More informationMedicare Part D Prescription Drug Coverage
Medicare Part D Prescription Drug Coverage Part 3 Version 9.0 June 22, 2015 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international
More informationA comparison of the Risk Equalization systems and the policy context of 5 European countries
IAAHS-Conference 5May07, Cape Town A comparison of the Risk Equalization systems and the policy context of 5 European countries Wynand P.M.M. van de Ven Professor of Health Insurance Department of Health
More informationA Roadmap to Better Care and a Healthier You
FROM COVERAGE TO CARE A Roadmap to Better Care and a Healthier You Step 2 Understand your health coverage Your ROADMAP to health 2 Understand your health coverage Check with your insurance plan or state
More informationSTAR CROSSED: WHY DOCS TRUMP HEALTH PLANS IN CMS STAR SCORES
Health and Life Sciences POINT OF VIEW STAR CROSSED: WHY DOCS TRUMP HEALTH PLANS IN CMS STAR SCORES AUTHORS Andrea Jensen, Senior Consultant Martin Graf, Partner An analysis of Medicare Advantage data
More informationJournal of Health Economics 19 2000 311 339 www.elsevier.nlrlocatereconbase. C.J.A. van Vliet, Frederik T. Schut, Erik M.
Ž. Journal of Health Economics 19 2000 311 339 www.elsevier.nlrlocatereconbase Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted
More informationMedicare Choice and Impact Study. September 2014
Medicare Choice and Impact Study September 2014 ehealth Medicare Choice and Impact Study - Introduction and Summary This report presents an analysis of over 22,000 consumers who used the online Medicare
More informationWhat Advisors Need to Know about Health- Care Planning
What Advisors Need to Know about Health- Care Planning June 18, 2013 by Dinesh Sharma Advisor Perspectives welcomes guest contributions. The views presented here do not necessarily represent those of Advisor
More informationMedigap Insurance 54110-0306
Medigap Insurance Overview A summary of the insurance policies to supplement and fill gaps in Medicare coverage. How to be a smart shopper for Medigap insurance Medigap policies Medigap and Medicare prescription
More informationHospitals and Health Systems:
Hospitals and Health Systems: An Inside Look at Employee Health Plan Strategies To Control Costs and Provide Access to Healthcare August 2010 Highlights Because of their dual role as benefit plan sponsor
More informationMVA Accident Questionnaire
MVA Accident Questionnaire Name Date Date of Accident Time of Accident Road conditions at time of accident Were you the driver? Were you the passenger? Where were you seated in the vehicle? FRONT BACK
More informationThe Elasticity of Demand for Health Care
The Elasticity of Demand for Health Care A Review of the Literature and Its Application to the Military Health System Jeanne S. Ringel Susan D. Hosek Ben A. Vollaard Sergej Mahnovski Prepared for the Office
More informationWhite Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors
White Paper Medicare Part D Improves the Economic Well-Being of Low Income Seniors Kathleen Foley, PhD Barbara H. Johnson, MA February 2012 Table of Contents Executive Summary....................... 1
More informationPrivate Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff
Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff Ibrahim Shehata April 27, 2006 Background Health expenditure is dominated by household direct out-ofpocket payments
More informationMortgage Protection Plan/Level Term Plan With/Without Critical Illness Cover
Metropolitan Police Friendly Society Berwick House, 8-10 Knoll Rise, Orpington, Kent, BR6 0EL Despatch: MPFS Orpington - Phone: 01689 891454 - Metphone: 2 Email: enquiries@mpfs.org.uk - Web: www.mpfs.org.uk
More information2015 Orange County HICAP Medicare Advantage Special Needs Plans Comparison Chart
Brand New Day Brand New Day Brand New Day Brand New Day Bridges Drug Savings Bridges Extra Care Harmony Healthy Heart Drug Savings dementia. dementia. chronic and disabling mental health conditions. chronic
More informationBasic Reimbursement - Medicare Part D Specifics
Basic Reimbursement - Medicare Part D Specifics 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance
More informationStatistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act
Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act Prepared for: National Association of Insurance Commissioners Prepared by: Milliman, Inc. James T. O Connor FSA, MAAA
More information2016 Medicare Supplement Insurance Plans
Mutual of Omaha Insurance Company 2016 Medicare Supplement Insurance Plans We ve got you covered. Go Play! 105831 Policy Forms MM20-21669 Plan A, MM21-21670 Plan B, MM22-22407 Plan C, MM23-22408 Plan D,
More informationINSIGHT on the Issues
INSIGHT on the Issues AARP Public Policy Institute Beyond Age Rating: Spreading Risk in Health Insurance Markets Age rating health insurance premiums currently a key issue in the health reform debate forces
More informationMaryland Health Connection
Maryland Health Connection What You Need To Know About Getting Health Coverage MarylandHealthConnection.gov Goals Today The importance of coverage What is Maryland Health Connection? Coverage options Qualified
More informationMoral Hazard. Question for this section. Quick review of demand curves. ECON 40447 Fall 2009
Moral Hazard ECON 40447 Fall 2009 First day of class, listed five unique characteristics of the health care sector Uncertainty Large role for federal govt Agency problem Non-profit sector Medical care
More informationCan You Purchase Life Insurance If You
Can You Purchase Life Insurance If You Are Diabetic Have Heart Disease Are Fighting MS Abused Drugs or Alcohol Have a History of Cancer Or Other Serious Illness InsuranceNebraska.org (800) 882-5009 The
More informationImproving risk adjustment in the Medicare program
C h a p t e r2 Improving risk adjustment in the Medicare program C H A P T E R 2 Improving risk adjustment in the Medicare program Chapter summary In this chapter Health plans that participate in the
More informationElderCare Medicare Health Plan Analyzer
ElderCare Medicare Health nalyzer 1999 Prism Innovations, Inc. All Rights Reserved ElderCare Medicare Health nalyzer Table of Contents Introduction 2 Explanations of New Health Plan Options 3 Analysis
More informationYou can usually only shop for insurance during a specific timeframe that occurs once a year called open enrollment.
Getting Started So many of us forget about health insurance until we need to use it. Even when we have insurance, sometimes we forget about the routine and preventive services that help us to get and stay
More informationClosing the Coverage Gap
MEDICARE PRESCRIPTION DRUG COVERAGE REVISED MAY 2013 Information Partners Can Use on: Closing the Coverage Gap The Affordable Care Act includes provisions to close the Medicare Part D prescription drug
More informationMassachusetts Health Connector logo. What Does National Health Care Reform Mean for You?
Massachusetts Health Connector logo What Does National Health Care Reform Mean for You? 1 National health care reform offers more opportunities for individuals, families, and small businesses to save on
More informationThe Swedish Pharmaceutical Reimbursement System
The Swedish Pharmaceutical Reimbursement System January 2007 www.lfn.se The Swedish Pharmaceutical Reimbursement System - A brief overview Sweden made some major changes to its reimbursement system in
More informationOptimal Health Insurance for Prevention and Treatment
Optimal Health Insurance for Prevention and Treatment Randall P. Ellis Department of Economics Boston University Willard G. Manning Harris School of Public Policy Studies The University of Chicago We thank
More informationAccountable Care Organization Workgroup Glossary
Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.
More informationPATIENT INFORMATION INSURANCE INFORMATION
(mm/dd/yyyy): Have you been to Physicians Urgent Care before? Yes No Arrival Time: If yes, when? Is this a follow-up to a previous visit: Yes No PATIENT INFORMATION Patient s First Name: Middle Name: Last
More information2016 Medicare Supplement Insurance Plans
Omaha Insurance Company A Mutual of Omaha Company 2016 Medicare Supplement Insurance Plans We ve got you covered. Go Play! 94994 Policy Forms NM20 Plan A, NM23 Plan F, NM34 High Deductible Plan F, NM24
More informationWhat is the overall deductible? Are there other deductibles for specific services?
Small Group Agility MS200 Coverage Period: Beginning on or after 01/01/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or
More informationMedicare Part B vs. Part D
Medicare Part B vs. Part D 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance for specific coding,
More informationPrivate Fee-For-Service ----- Beneficiary Questions and Answers
Private Fee-For-Service ----- Beneficiary Questions and Answers 1. What Is a Private Fee-For-Service Plan? A Private Fee-For-Service plan is a Medicare Advantage health plan offered by a private insurance
More informationWe decided to start with the New Basics!
What employees think of healthcare Confusing Uhh, What?... Frustrating I give up! We decided to start with the New Basics! Agenda City of Dallas Challenges (what caused our approach to benefits to change)
More informationRoadmap for Medicare Navigating Medicare Part D. A guide for seniors and caregivers
Roadmap for Medicare Navigating Medicare Part D A guide for seniors and caregivers Roadmap for Medicare: Getting Oriented This Guide offers information and advice for choosing a Medicare Part D prescription
More informationMedicare Part D Prescription Drug Coverage
Medicare Part D Prescription Drug Coverage Part 3 Version 6.0 September 25, 2012 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and
More informationUNIVERSITY OF VIRGINIA HEALTH PLAN 2015 SCHEDULE OF BENEFITS CHOICE HEALTH
UNIVERSITY OF VIRGINIA HEALTH PLAN 2015 SCHEDULE OF BENEFITS CHOICE HEALTH SERVICES PROVIDED Direct Access through UVa Provider Network 1. PLAN COINSURANCE Applies to all expenses unless otherwise stated.
More informationHNE Premier 1 (HMO) and HNE Premier 2 (HMO)
2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I
More informationInsurance Markets Ready or Not: Consumers Face New Health Insurance Choices. Employer-based. Insurance Premium. Contribution.
Insurance Markets Ready or Not: Consumers Face New Health Insurance Choices Introduction Not long ago, most working Californians, at least those working for large or midsize companies, could expect a standard
More informationMedicare. Medicare Overview. Medicare Part D Prescription Plans. Medicare
58 requires enrollment as soon as a retiree, spouse or dependent of a retiree is eligible for. Parts A & B MUST be elected. Overview There are three parts to : Hospital Insurance (also called Part A. Your
More informationGetting Started with Medicare Beginning Medicare Training
Getting Started with Medicare Beginning Medicare Training This Medicare Counselor Training program was developed under a grant from UnitedHealthcare through a joint project with the National Association
More informationORANGE COUNTY EYE INSTITUTE
ORANGE COUNTY EYE INSTITUTE *Note: It is the patient s responsibility to file insurance claims if we are not contracted with your insurance company. *Note: Be aware that most medical insurance plans do
More informationIn-Network: $5,000 self-only / $10,000 family, not to exceed $6,450 from any one person. Does not apply to preventive care or vision hardware.
Personal Alliance 5000 Bronze ON Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2016-12/31/2016 Coverage for: Self Only / Family Plan Type: HMO HSA This
More informationPublic / private mix in health care financing
Public / private mix in health care financing Dominique Polton Director of strategy, research and statistics National Health Insurance, France Couverture Public / private mix in health care financing 1.
More informationBrandeis University The Heller School for Social Policy and Management
Health Care Cost Management in Massachusetts: A Discussion of Options Meeting #3: Boston, MA Conference Report Sponsored by: Health Care Cost Containment and Value-Based Insurance Design Presenter: Michael
More informationYour Medicare Options Guide Book
Your Medicare Options Guide Book H4152_ageinoptionsbook123 Accepted Turning 65? Time to get informed. Maybe you re not thinking about retirement yet. These days people are working and enjoying life longer
More informationFINANCE AND INSURANCE. Financial Aspects of Lung Transplantation
FINANCE AND INSURANCE Financial Aspects of Lung Transplantation Transplantation is a costly treatment for lung disease and it is important for you to plan ahead and be well informed of your needs and your
More informationClick this button to place your order.
Medicare 33rd Edition 2016 What you need to know about Medicare in simple, practical terms. Click this button to place your order. 2016 MEDICARE CONTENTS 1 2 3 4 5 6 Published By PAGE INTRODUCTION Are
More informationSIMPLICITY. 2015 Your Plan Explained
Hello SIMPLICITY 2015 Your Plan Explained PFIZER UnitedHealthcare Group Medicare Advantage (PPO) Effective January 1, 2015, through December 31, 2015 Group Number: 12367, 12368 Benefit Highlights UnitedHealthcare
More informationYour guide to UnitedHealthcare
Your guide to UnitedHealthcare Face the future with confidence The benefits environment remains challenging. Uncertainty reigns as a wave of new regulation sweeps across the industry. Costs continue to
More informationHealth Plan Comparison
Freedom. Choice. Flexibility. For Agent Use Only Health Plan Comparison Starmark Signature Plans Starmark Consumer Health Plans Fully insured health plans specifically for small businesses. Flexible plan
More informationThings you need to know about Medicare.
Things you need to know about Medicare. 1 2 3 1OPTION Original Medicare We re here to help. Approaching 65 is an important milestone in life, and becoming eligible for Medicare is part of that. Whether
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
Page1 G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify G.6 When to Notify G.11 Case Management Services G.14 Special Needs Services G.16 Health Management Programs
More informationAbout to Retire: Preparing for Medicare Patient Financial Services Agenda Medicare Enrollment Covered Services Medicare-covered covered Preventive Services Agenda, continued Advance Beneficiary Notice
More information2006 Choosing a Medigap Policy:
CENTERS FOR MEDICARE & MEDICAID SERVICES 2006 Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare This official government guide can help you Learn what a Medigap (Medicare
More informationSolutions for Today Flexibility for Tomorrow.
Solutions for Today Flexibility for Tomorrow. Medicare Products and Services For More Information call our Senior Care Specialist, Raun Lynch at 856.380.5079 Or visit us on the web at www.cbdi-inc.com
More informationSimple. 2015 Benefit Guide. Personal. Empowering.
2015 Benefit Guide Simple. Personal. Empowering. An easy-to-use guide to understanding your UnitedHealthcare benefits offered by the Cook County Pension Fund. Open Enrollment is November 1 - November 30
More informationHow To Pay For Health Care With A Health Care Plan With A Premium Rate Of $1,000 A Year
Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual &
More information801501-MSP-WI. Medicare Supplement
801501-MSP-WI Medicare Supplement 1 Medicare supplement Not so surprisingly, seniors have questions about health care - especially Medicare. Even with all of the information out there you may still be
More informationMedicare Made Simple
Medicare Made Simple 877-413-1556 Who are we? MedicareMall is the nation s premier enrollment center for Medicare Supplement Plans, Medicare Part D (prescription drug plans,) and Vision & Hearing Insurance
More informationMedical Mutual of Ohio 2060 East 9th Street Cleveland, OH 44115-2263 Visit MedMutual.com
Z6188 R7/08 Medical Mutual of Ohio 2060 East 9th Street Cleveland, OH 44115-2263 Visit MedMutual.com P R O D U C T S A N D S E R V I C E S Small-Group Health Insurance 1 Welcome to Medical Mutual Medical
More informationNorth Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS
North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS Often times in the early care and education field we
More informationHow the New Health Care Law Benefits You
How the New Health Care Law Benefits You Congress enacted a new health care law which brings a number of benefits to all Americans, including people over 50. Some of these changes you will see this year.
More informationMember s responsibility (deductibles, copays, coinsurance and dollar maximums)
MICHIGAN CATHOLIC CONFERENCE January 2015 Benefit Summary This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Healthy Heart (HMO) Alameda and Stanislaus counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0171 CMS Accepted 09172015
More informationOutline of Medicare Supplement Coverage
Outline of Medicare Supplement Coverage Cover page 1 of 2 Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 Plans A, B, C, D, F, high deductible F, G, L, M This
More informationFor Retirees of City of Memphis. Features that Add Value. Freedom of Choice. Quality Service Is Part of Quality Care
For Retirees of City of Memphis Features that Add Value The Cigna Medicare Surround indemnity medical plan helps pay some of the health care costs that your Medicare Part A or Part B do not cover such
More information