Managed Care

Prototypes offer insight into Medicare costs

A Kaiser Family Foundation report examining the cost implications of giving Medicare recipients coverage options has found that there are "no obvious 'right' choices for beneficiaries." The report, Paying for Choice: The Cost Implications of Health Plan Options for People on Medicare, estimates a range of spending for three different prototype beneficiaries in eight markets.

"Spending is often lower in Medicare+Choice plans, but this is not always the case," the authors found. The question of whether an M+C plan will be available to beneficiaries is a complicating factor. And M+C — as is the case with all options — is subject to geographic variation. For instance, a frail, 80-year-old woman who chooses the least expensive medigap plan would spend $6,376 in Manchester, N.H., but $9,520 if she lived in Miami. On the other hand, she could spend as little as $1,342 for the cheapest M+C plan in Miami, but as much as $7,082 for the lowest-cost M+C option in Seattle. The other markets examined in the study are Oakland, Calif., Minneapolis, Chicago, Dodge City, Kan., and Baltimore.

M+C often least expensive choice

Estimates for a 50-year-old man with disabilities
  Medigap M+C No supplemental insurance Range of costs across all sources
Premium range $432–14,412 $0–1,194 $0 $0–14,412
Nonpremium range $7,445–11,058 $6,010–11,049 $12,335–12,380 $7,445–12,380
Total range of costs $8,541–21,857 $6,010–11,049 $12,335–12,380 $6,010–21,857
Estimates for a healthy 65-year-old woman
  Medigap M+C No supplemental insurance Range of costs across all sources
Premium range $407–8,074 $0–1,194 $0 $0–8,074
Nonpremium range $1,587–2,808 $1,342–8,134 $10,546–10,673 $1,342–10,673
Total range of costs $2,683–9,661 $1,342–8,962 $10,546–10,673 $1,342–12,482
Estimates for a frail 80-year-old woman
  Medigap M+C No supplemental insurance Range of costs across all sources
Premium range $528–8,074 $0–1,194 $0 $0–8,074
Nonpremium range $4,408–8,532 $1,342–8,134 $10,546–10,673 $1,342–10,673
Total range of costs $6,376–12,482 $1,342–8,962 $10,546–10,673 $1,342–12,482

SOURCE: PAYING FOR CHOICE: THE COST IMPLICATIONS OF HEALTH PLAN OPTIONS FOR PEOPLE ON MEDICARE, KAISER FAMILY FOUNDATION, MENLO PARK, CALIF.

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