Aging

This article uses the 2006 to 2012 Medicare Current Beneficiary Survey, to examine disease-specific switching rates between TM and MA and disease-specific ratios of mean baseline total Medicare expenditures of beneficiaries remaining in the same plan (stayers) vs those switching to another plan (switchers), respectively. We focused on beneficiaries with 1 or more of 10 incident diagnoses. Beneficiaries with a new diagnosis of Alzheimer disease and related dementias, hypertension, and psychiatric disorders had relatively high rates of switching into MA plans and low rates of switching out of MA plans. Among those with new diagnoses of psychiatric disorders and diabetes, more costly beneficiaries (those with higher costs) switched into MA plans. For cancer, more costly beneficiaries remained in MA plans.

Medicare pays for 100% of postacute care provided by skilled nursing facilities (SNFs) during the first 20 days within a benefit period. However, on the 21st day, most patients become responsible for a daily copayment of more than $150. This copayment may present a significant financial burden for some patients—particularly those with limited economic means—and motivate them to discharge from SNFs on the 20th day of care based on their financial resources rather than their recovery status. In this article, the researchers examine whether patterns of SNF discharge are associated with this change in Medicare payment responsibility on day 20.   

The State of Washington, as part of a State Innovation Model (SIM) grant, is changing the payment model within state employee health insurance plans. The system is moving away from traditional fee-for-service reimbursement to value-based payment, through insurance design (the creation of accountable care network insurance products) and bundled payment strategies. New plans were rolled out in January 2016 (enrollment occurred in late 2015), with the stated goal of getting 80% of state employees covered by plans that contain value-based purchasing within the next 5 years. The goal of payment reform is to improve member experience, member health, and cut costs. However, changing health insurance during employment can, directly and indirectly, change labor market outcomes. Decreasing costs of insurance could lead people to remain in the state-employment sector longer. However, it could also influence retirement timing, by changing the relative costs of insurance through improving health.

This paper examines who switches to value-based insurance, where the insurance explicitly decreases premiums without changing out-of-pocket costs. We find that the peak age for switching insurance plans is 35–45, even among the subsample of individuals who would not need to change their usual sources of care. Second, we look at the labor market activity – both leaving the state-employee sector and retiring from state-employment – and find that younger workers with value-based insurance plans are less likely to leave state employment. Further, we find evidence of value-based insurance, available at a reduced cost to both employees and retirees, leads to a shifting downward in the distribution of retirement age. While these findings support the existence of both the price and income effects, the effect sizes are rather small.

This article examines how patient outcomes and Medicare spending are affected by the decision to discharge patients to home with home health care vs to a skilled nursing facility for postacute care. The authors find that among Medicare beneficiaries eligible for postacute care at home or in a skilled nursing facility, discharge to home with home health care was associated with higher rates of readmission, no detectable differences in mortality or functional outcomes, and lower Medicare payments.

This article estimates out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and examine how these costs vary by insurance coverage.