In summary, we identified four groups of states that differed in their use of Medicaid managed care on the basis of the 12 indicators we included in our analysis. A handful of these indicators--namely Medicaid enrollment in MCOs and PCCM programs, HMO penetration rates, and the concentration of low-income individuals that lived in urban areas--had significant influence on how states grouped. In c

All Medicare beneficiaries enrolled in the 22 cost plans had multiple MA options available to them. Nearly all beneficiaries enrolled in cost plans had at least 5 MA plans serving their county in June 2009, and more than 57 percent had a choice of 15 or more MA plans. Some of the differences between cost plans and MA plans that affect beneficiaries are out-of-network coverage, enrollment periods,

Our review found articles that measured the extent of concentration in private health insurance markets or focused on the relationship between competition in these markets and other variables, though the findings of these studies should be interpreted with caution. Several articles identified through our review examined the extent of concentration in private health insurance markets, though this

Since the early 1980s, health maintenance organizations (HMO) have entered into risk-based contracts with Medicare and offered beneficiaries an alternative to the traditional fee-for-service (FFS) program. By 1997, 5.2 million Medicare beneficiaries were enrolled in an HMO. Although Medicare HMOs were available in most urban areas, they were often unavailable in rural areas. Medicare+Choice (M+C)

The six states reviewed had in place a variety of protections, established prior to the economic downturn, to assist unemployed individuals in maintaining health insurance coverage: State-mandated continuation coverage, which required small businesses to extend their group health coverage to former employees and their families who choose to pay for it. Guaranteed conversion, which required insure

GAO noted that: (1) two states are enrolling a small number of dual eligibles in limited geographic areas into integrated care programs, and two additional states plan to implement programs by 2001; (2) officials in these four states view their initial efforts as stepping stones and plan to make their programs more widely available; (3) since the 1995 approval of an integrated care program in Min

GAO noted that: (1) DOD's network adequacy requirements are based on California's Knox-Keene Act, which provides guidelines for health maintenance organizations on numerous aspects of access to care, including network adequacy ratios and the amount of time it takes to drive to a provider's office; (2) in addition to following these standards, most of DOD's managed care support contractors that ad

GAO noted that: (1) in the first year of DOD's Medicare subvention demonstration, over one-fifth of Medicare-eligible military retirees in the demonstration areas enrolled in Senior Prime, DOD's HMO pilot for seniors, although enrollment rates differed markedly across the six demonstration sites; (2) two sites reached their enrollment targets and started putting applicants on a waiting list; cons

GAO noted that: (1) Medicare beneficiaries' ability to obtain needed care does not appear to have decreased since the implementation of the SNF PPS, although some patients may stay longer in the hospital before being admitted to a nursing home or may receive care from other post-acute-care providers; (2) the PPS does appear to have affected the willingness or ability of some nursing homes to acce

GAO noted that: (1) although all health plans are required to provide at least the package of benefits available in traditional fee-for-service (FFS), most plans provide many more benefits; (2) the extra benefits result because projected Medicare payments tend to exceed plans' estimated costs of providing the FFS package of benefits, and the program requires that the difference between payments a