Beneficiaries (41 - 50 of 284 items)
Medicare Advantage: 2011 Profits Similar to Projections for Most Plans, but Higher for Plans with Specific Eligibility Requirements
GAO-14-148: Published: Dec 19, 2013. Publicly Released: Jan 22, 2014.
Medicare Advantage (MA) organizations' actual medical expenses, nonmedical expenses (such as marketing, sales, and administration) and profits as a percentage of total revenue were, on average, similar to projected values for plans available to all beneficiaries in 2011, the most recent year for which data were available at the time of the request for this work. MA organizations' actual medical ex...
Medicare Advantage: Special Needs Plans Were More Profitable, on Average, than Plans Available to All Beneficiaries in 2011
GAO-14-210R: Published: Dec 19, 2013. Publicly Released: Jan 22, 2014.
Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-lev...
Medicare: Continuous Insurance before Enrollment Associated with Better Health and Lower Program Spending
GAO-14-53: Published: Dec 17, 2013. Publicly Released: Jan 16, 2014.
Beneficiaries with continuous health insurance coverage for approximately 6 years before enrolling in Medicare were more likely than those without prior continuous insurance to report being in good health or better during the first 6 years in Medicare. In particular, having prior continuous insurance raised the predicted probability that a beneficiary reported being in good health or better by nea...
Medicare Part D: CMS Has Implemented Processes to Oversee Plan Finder Pricing Accuracy and Improve Website Usability
GAO-14-143: Published: Jan 10, 2014. Publicly Released: Jan 10, 2014.
The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers Medicare, uses data checks and quality measures to oversee the accuracy of Part D plan pricing information on the Plan Finder interactive website. Part D sponsors may have multiple contracts with CMS to provide drug coverage, with each contract covering one or mo...
Medicare Program Integrity: Contractors Reported Generating Savings, but CMS Could Improve Its Oversight
GAO-14-111: Published: Oct 25, 2013. Publicly Released: Nov 25, 2013.
The Centers for Medicare and Medicaid Services (CMS) paid its Zone Program Integrity Contractors (ZPIC) about $108 million in 2012. ZPICs reported spending most of this funding on fraud case development, primarily for investigative staff, who in 2012 reported conducting about 3,600 beneficiary interviews, almost 780 onsite inspections, and reviews of more than 200,000 Medicare claims.ZPICs reporte...
Medicare Supplemental Coverage: Medigap and Other Factors Are Associated with Higher Estimated Health Care Expenditures
GAO-13-811: Published: Sep 19, 2013. Publicly Released: Oct 21, 2013.
GAO's analysis of the Centers for Medicare & Medicaid Services' 2010 Medicare Current Beneficiary Survey (MCBS) showed that estimated average total health care expenditures were higher for beneficiaries with Medigap or employer-sponsored coverage than for beneficiaries with traditional fee-for-service (FFS) Medicare only. While estimated average expenditures were lower for beneficiaries with Medic...
Medicare Information Technology: Centers for Medicare and Medicaid Services Needs to Pursue a Solution for Removing Social Security Numbers from Cards
GAO-13-761: Published: Sep 10, 2013. Publicly Released: Oct 17, 2013.
The Centers for Medicare and Medicaid Services (CMS)--which is the agency within the Department of Health and Human Services (HHS) responsible for administering Medicare--has not taken needed steps, such as designating a business owner and establishing a business case for an information technology (IT) project, that would result in selecting and implementing a technical solution for removing Socia...
Dental Services: Information on Coverage, Payments, and Fee Variation
GAO-13-754: Published: Sep 6, 2013. Publicly Released: Sep 12, 2013.
Overall, trends in dental coverage show little change from 1996 to 2010--around 62 percent of individuals had coverage. The percentage of the population with private dental coverage decreased from 53 to 50 percent. Dental coverage through Medicaid or the State Children's Health Insurance Program (CHIP), which was established in 1997, rose from 9 to 13 percent. The increase was due primarily to an...
Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny
GAO-13-525: Published: Jul 19, 2013. Publicly Released: Aug 1, 2013.
The number of Medicare prostate cancer-related intensity-modulated radiation therapy (IMRT) services performed by self-referring groups increased rapidly, while declining for non-self-referring groups from 2006 to 2010. Over this period, the number of prostate cancer-related IMRT services performed by self-referring groups increased from about 80,000 to 366,000. Consistent with that growth, expend...
Medicare: Action Needed to Address Higher Use of Anatomic Pathology Services by Providers Who Self-Refer
GAO-13-445: Published: Jun 24, 2013. Publicly Released: Jul 15, 2013.
Self-referred anatomic pathology services increased at a faster rate than non-self-referred services from 2004 to 2010. During this period, the number of self-referred anatomic pathology services more than doubled, growing from 1.06 million services to about 2.26 million services, while non-self-referred services grew about 38 percent, from about 5.64 million services to about 7.77 million service...