Health insurance (41 - 50 of 335 items)
Federal Employees Health Benefits Program: Competition and Other Factors Linked to Wide Variation in Health Care Prices
GAO-05-856: Published: Aug 15, 2005. Publicly Released: Sep 14, 2005.
Congress is concerned about the health care spending burden facing the Federal Employees Health Benefits Program (FEHBP), the largest private health insurance program in the country. Health care spending per person varies geographically, and the underlying causes for the spending variation have not been fully explored. Understanding market forces and other factors that may influence health care sp...
Medicare: Concerns Regarding Plans to Transfer the Appeals Workload from SSA to HHS Remain
GAO-05-703R: Published: Jun 30, 2005. Publicly Released: Aug 1, 2005.
Medicare--the federal health insurance program that covers the nation's elderly and disabled--annually processes over 1 billion medical claims for services provided to beneficiaries. The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), administers the Medicare program with the assistance of its claims administration contractors. Th...
Retiree Health Benefits: Options for Employment-Based Prescription Drug Benefits under the Medicare Modernization Act
GAO-05-205: Published: Feb 14, 2005. Publicly Released: Feb 14, 2005.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created a prescription drug benefit for beneficiaries, called Medicare part D, beginning in January 2006. The MMA included incentives for sponsors of employment-based retiree health plans to offer prescription drug benefits to Medicare-eligible retirees, such as a federal subsidy when sponsors provide benefits meeting...
Medicare: CMS's Program Safeguards Did Not Deter Growth in Spending for Power Wheelchairs
GAO-05-43: Published: Nov 17, 2004. Publicly Released: Dec 15, 2004.
Medicare spending for power wheelchairs--one of the program's most expensive items of durable medical equipment (DME)--rose more than fourfold from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that some of the payments may have been improper...
Medicare Physician Fee Schedule: CMS Needs a Plan for Updating Practice Expense Component
GAO-05-60: Published: Dec 13, 2004. Publicly Released: Dec 13, 2004.
Medicare's payments for the costs physicians incur in operating their practices are based on two sets of estimates: total practice expenses and resource estimates for individual services. Total practice expense estimates were derived from American Medical Association (AMA) physician surveys, which the Centers for Medicare & Medicaid Services (CMS) refines with supplemental data submitted by medica...
Medicare: Accuracy of Responses from the 1-800-MEDICARE Help Line Should Be Improved
GAO-05-130: Published: Dec 8, 2004. Publicly Released: Dec 8, 2004.
In March 1999, the Centers for Medicare & Medicaid Services (CMS) implemented a telephone help line--1-800-MEDICARE--to provide information about program eligibility, enrollment, and benefits. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) directed GAO to examine several issues related to this 24-hour help line and the customer service representatives (CSRs) who s...
Medicare: Advisory Opinions as a Means of Clarifying Program Requirements
GAO-05-129: Published: Dec 8, 2004. Publicly Released: Dec 8, 2004.
Health care providers are concerned about the quality of Medicare guidance issued by the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS). Specifically, they have reported that (1) they receive unclear guidance on program requirements and (2) because policies and procedures change frequently, they may rely on obsolete guidance, resu...
Medicare Physician Payments: Concerns about Spending Target System Prompt Interest in Considering Reforms
GAO-05-85: Published: Oct 8, 2004. Publicly Released: Oct 8, 2004.
Concerns were raised about the current system Medicare uses to determine annual changes to physician fees--the sustainable growth rate (SGR) system--when fees were reduced by 5.4 percent in 2002. Subsequent administrative and legislative actions modified or overrode the SGR system, resulting in fee increases for 2003, 2004, and 2005. However, projected fee reductions for 2006-2012 have raised new...
Medicare: Incomplete Plan to Transfer Appeals Workload from SSA to HHS Threatens Service to Appellants
GAO-05-45: Published: Oct 4, 2004. Publicly Released: Oct 4, 2004.
The Medicare appeals process has been the subject of widespread concern in recent years because of the time it takes to resolve appeals of denied claims. Two federal agencies play a role in deciding appeals--the Department of Health and Human Services (HHS) and the Social Security Administration (SSA). Currently, neither agency manages and oversees the entire multilevel process. In the Medicare Pr...
Medicare Demonstration PPOs: Financial and Other Advantages for Plans, Few Advantages for Beneficiaries
GAO-04-960: Published: Sep 27, 2004. Publicly Released: Sep 27, 2004.
Preferred provider organizations (PPO) are more prevalent than other types of health plans in the private market, but, in 2003, only six PPOs contracted to serve Medicare beneficiaries in Medicare+Choice (M+C), Medicare's private health plan option. In recent years, the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, initiated two demonstrations that include a...