Medicare Payment Policy

FIGURE
FIguRe
13-2
13–2
MA bids in relation to FFS spending levels
Note: MA (Medicare Advantage), FFS (fee-for-service).
Source: Note: MedPAC Note and analysis Source are of MA in InDesign. bid and FFS expenditure data from CMS.
Source:
1.40
1.30
1.20
1.10
1.00
0.90
0.80
0.70
0.60
1.17
1.11
1.07
$560–$645
First (lowest)
FFS spending quartile
$645–$690
For 2013, the base county benchmarks (in nominal percent in 2012) bid to provide Part A and Part B benefits
dollars and before any quality bonuses are applied) for less than what the FFS Medicare program would spend
average Notes approximately about the this same as graph: the benchmarks for to provide these benefits. These plans are projected to
2012. However, • Data for is in 2013, the 93 datasheet. percent of Make MA enrollees updates are in the enroll datasheet. 60 percent of nonemployer MA enrollees in 2013.
projected to be in plans that will receive add-ons to their About 0.8 million beneficiaries, excluding those enrolled
• WATCH FOR GLITCHY RESETS WHEN YOU UPDATE DATA!!!!
benchmarks through the PPACA quality provisions or the in employer group MA plans, are projected to enroll in
2012 to • 2014 The CMS column quality totals demonstration were added program. manually. These plans that bid lower than 75 percent of FFS spending.
quality bonus • I had add-ons to manually range from draw 3 percent tick marks to 10 percent and axis lines On the because other hand, they a kept similar resetting number when of beneficiaries I changed are any data.
in 2013.
projected to enroll in plans that bid at least 115 percent of
• I can’t delete the legend, so I’ll just have to crop it out in InDesign.
FFS spending.
MA bids • and Use payments direct selection for different tool to select plan types items for modification. Otherwise if you use the black selection tool, they
Figure 13-2, illustrating over 2,000 plan bids (employer
The lack default of growth when in the you benchmarks change the may data. have exerted
plans, SNPs, and plans in the territories were excluded),
fiscal pressure • Use on paragraph the plans and styles encouraged (and object them to styles) better to format. shows how plans bid relative to FFS for service areas
control costs and lower their bids for 2013. The average
with different ranges of FFS spending. The first three FFS
bid for 2013 is 96 percent of the projected FFS spending
spending ranges roughly correspond to the FFS ranges in
for similar beneficiaries, down from 98 percent in 2012.
the first three rate quartiles in the PPACA payment rules.
About 56 percent of nonemployer plans (up from 46
296 The Medicare Advantage program: Status report
MA bids...
Medicare Advantage bids in relation to FFs spending levels, 2013
1.13
1.09
1.03
Second
FFS spending quartile
1.07
1.02
0.96
$690–$750
Third
FFS spending quartile
1.01
0.94
0.89
$750–$825
0.93
0.86
0.81
$825–$900
Fourth (highest)
FFS spending quartile
Average FFS spending per beneficiary in given service area (in dollars)
75th percentile
Median
25th percentile
0.82
0.76
0.71
$900–$1,350