scholarly journals Compared to commercially insured patients, Medicare advantage patients adopt newer diabetes drugs more slowly and adhere to them less

2021 ◽  
Author(s):  
James H Flory ◽  
Jing Li ◽  
Ghadeer K. Dawwas ◽  
Charles E. Leonard
Keyword(s):  
Medicare Advantage ◽  
Insured Patients

scholarly journals Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients

2017 ◽  
Vol 76 (2) ◽  
pp. 229-239 ◽  
Author(s):  
Keith D. Lind ◽  
Claire M. Noel-Miller ◽  
Lindsey R. Sangaralingham ◽  
Nilay D. Shah ◽  
Erik P. Hess ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Older Patients ◽  
Claims Data ◽  
Veterans Affairs ◽  
Inpatient Stay ◽  
Medicare Advantage ◽  
Younger Patients ◽  
Insured Patients ◽  
Increasing Trends ◽  
Privately Insured

Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.

scholarly journals Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020

2021 ◽  
Author(s):  
Kao-Ping Chua ◽  
Rena M Conti ◽  
Nora V Becker
Keyword(s):  
Cost Sharing ◽  
Financial Burden ◽  
Ancillary Services ◽  
Medicare Advantage ◽  
Cross Sectional ◽  
Outcomes Measures ◽  
Ambulance Transport ◽  
Insured Patients ◽  
Sectional Analysis ◽  
Privately Insured

IMPORTANCE: Many insurers waived cost-sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021. OBJECTIVE: To estimate out-of-pocket spending for COVID-19 hospitalizations in 2020 DESIGN: Cross-sectional analysis SETTING: IQVIA PharMetrics Plus for Academics Database, a national claims database PARTICIPANTS: COVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020 MAIN OUTCOMES/MEASURES: Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport) RESULTS: Analyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations. CONCLUSIONS: Few COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.

Marketing on Hold for Medicare Advantage Plans

2007 ◽  
Vol 38 (8) ◽  
pp. 60
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Medicare Advantage

Abstract # P-18: Economic Burden of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease in Commercially-Insured Patients in the United States

2016 ◽  
Vol 22 ◽  
pp. 21-22
Author(s):  
Weijia Wang ◽  
Eileen M. Farrelly ◽  
Sharash Shetty ◽  
Dana Stafkey-Mailey ◽  
Stephen D. Sander ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Economic Burden ◽  
The United States ◽  
Insured Patients

Congress Eyes Medicare Advantage Pay for Fee Fix—Again

2008 ◽  
Vol 36 (4) ◽  
pp. 68
Author(s):  
ALICIA AULT
Keyword(s):  
Medicare Advantage

CMS Proposes Medicare Advantage Changes

2007 ◽  
Vol 35 (7) ◽  
pp. 60
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Medicare Advantage

Virtual Diabetes Prevention Program—Effects on Medicare Advantage Health Care Costs and Utilization

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 45-LB
Author(s):  
VINAY CHIGULURI ◽  
DOUGLAS BARTHOLD ◽  
RAJIV GUMPINA ◽  
CYNTHIA CASTRO SWEET ◽  
JASON PIERATT ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Medicare Advantage ◽  
Program Effects ◽  
Care Costs
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