Proposals Related to: Beneficiary choice
The MA program was designed to have health plan sponsors compete for enrollees, and today most Medicare beneficiaries have an extensive choice of MA plan options. One tool to help beneficiaries make more informed choices about which plan best suits their needs is CMS’s Medicare Plan Finder. MA plan sponsors also market their plan offerings directly to beneficiaries and through brokers and provide plan information (such as lists of physician networks) on company websites. Once a beneficiary is enrolled in an MA plan, plan sponsors are required annually to send additional information such as how the plan’s coverage has changed from one year to the next. Perhaps because choosing from among a large number of options is daunting, relatively few MA enrollees switch plans during each year’s annual enrollment period. Some analysts believe that limitations, inaccuracies, or poor incentives in these sources of information keep beneficiaries from making informed decisions.
Some MA enrollees may decide that they would like to switch from an MA plan to original Medicare during the program’s annual enrollment period. However, original Medicare’s cost sharing can be very high with no out-of-pocket maximum, which is the reason many beneficiaries choose to purchase a Medicare supplemental (Medigap) policy. For individuals who would like to disenroll from an MA plan, their ability to do so can be constrained by rules for guaranteed-issue rights that determine when private insurers must make Medigap policies available for sale.
Proposals in this category would require changes to the tools beneficiaries use when considering MA plan options; some would also revise guaranteed-issue rights to purchase Medigap policies.
NOTE: Entries with grey backgrounds are Georgetown estimates. Entries with white backgrounds are either descriptive information or analysis made by or for the proposal authors.
| Proposal | Effects on beneficiaries | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Short description | Category | Author | Federal savings (-$) or costs (+$) | Access to plans | Enrollee costs | Supplemental benefits | Part B premiums | Other affected stakeholders | |
Key:
- Federal savings or costs. When available, we provide original estimates from source materials by the proposal author(s) or from the Congressional Budget Office. Authors prepared estimates for some proposals at a time when plan enrollment and payments differ from today, and thus estimates of savings or costs should be interpreted cautiously. When no author’s estimate was available, Georgetown provided an estimate, as indicated by grey highlighting. Click Details for more information about savings or costs for a specific proposal.
Estimates in source materials prepared by the author(s) cover different numbers of years and windows of time. To give website users a consistent sense of magnitude, we categorized proposals by whether its estimate was approximately less than $10 billion over 5 years or greater than or equal to that amount. Thus, in this column,- +$ indicates anticipated costs to the federal government of less than $10 billion over 5 years.
- +$$ indicates anticipated costs of $10 billion or more over 5 years.
- –$ indicates anticipated savings to the federal government of less than $10 billion over 5 years.
- –$$ indicates anticipated savings of $10 billion or more over 5 years.
- We list a question mark for proposals in which the author(s) would need to specify more detail to estimate federal spending.
- Effects on beneficiaries. When available, the estimate was provided by the proposal author(s) within the cited source materials. When no author’s estimate was available, Georgetown provided an estimate, as indicated by grey highlighting. In the four columns under this header,
- Up arrows indicate anticipated greater access to plans, higher costs (premiums and cost sharing) for plan enrollees, more availability of extra benefits, or higher Part B premiums applicable to all beneficiaries.
- Down arrows indicate the reverse effects.
- Combined up and down arrows indicate mixed effects, such as up for some categories of beneficiaries and down for others.
- Categories may also be reported as “minimal or no effect” or “not applicable.”
- We list a question mark for proposals in which the author(s) would need to specify more detail to estimate effects on beneficiaries.
- Click Details for more information about beneficiary effects for a specific proposal.
- Other affected stakeholders. This column reports any stakeholders other than Medicare beneficiaries likely to be affected significantly by the proposal. Click Details for more information about a specific proposal.