Monitoring Medicare Advantage

Congress has continued to change the private plan choices available to Medicare beneficiaries. Under the Balanced Budget Act of 1997, the former Medicare risk contracting program consisting of health maintenance organizations was folded into a new Medicare+Choice program that included options for preferred provider organizations (PPOs) and other forms of managed care, as well as a new private fee-for-service option. When creating the new Medicare prescription drug program in 2003, Congress changed the program's name to Medicare Advantage and authorized additional program choices, including special needs plans and regional PPOs. Yet, studies have shown that many beneficiaries don't understand basic Medicare, let alone these changing choices they have historically faced.

Since the late 1990s, Mathematica has conducted wide-ranging studies for the Robert Wood Johnson Foundation, the Commonwealth Fund, and the Kaiser Family Foundation to provide credible and timely information on how Medicare beneficiaries responded to these changes. Specifically, we monitored how available choices changed, how well beneficiaries understood these choices, and what information helped them most. We also looked at the implications of their choices.

Our recent work for the Kaiser Family Foundation and others continues to monitor Medicare Advantage and private plans more broadly, including the new prescription drug plans. Mathematica's analysis supports the Kaiser Family Foundation's Medicare Health and Prescription Drug Plan Tracker that makes data on choice and enrollment accessible to those seeking to understand trends both locally and at the state level, as well as nationally. Two new issue briefs from this work describe changes in the private plan market and effects on beneficiaries. The first details the different types of plan options available to people on Medicare, including Medicare Advantage plans (such as Medicare HMOs, PPOs, and private fee-for-service plans) and new stand-alone prescription drug plans. The second brief describes key characteristics of the organizations that offer the new Medicare drug benefit and analyzes how companies are positioning themselves to attract Medicare enrollees.

As private plans continue to be a focal point for changing Medicare in the future, our work will continue to provide policymakers with a better understanding of the dynamics of the system—the important connections between public policy and market behavior—to facilitate a successful transition.

View a list of reports from our studies of Medicare Advantage/Medicare+Choice.

Back to Top