Forum Session

Getting the Price Right: Ensuring Access and Promoting Efficiency in Medicare Advantage
May 17, 2013


Kathryn Linehan


The Medicare Advantage (MA) program allows beneficiaries to receive their Medicare Part A and B benefits through a private health plan. Beneficiaries enroll in these plans for a variety of reasons, including a preference for managed care, increased predictability of out-of-pocket spending, and in some cases, lower cost sharing or additional benefits. Setting the payment rates for private plans and adjusting payments to promote beneficiaries’ access and program efficiency has proven difficult. The latest round of private plan payment adjustments in the Patient Protection and Affordable Care Act of 2010 (ACA) sought to reduce payments to these plans in light of evidence that they were more expensive than traditional Medicare. Concerns about the rate of growth in Medicare spending have focused policymakers on ways to make the Medicare program a more efficient purchaser of all services, including MA plans, leading some to suggest further refinements to the current payment system or moving to a more competitively determined payment rate. This Forum session examined the Medicare Advantage program and its payment system; recommendations to improve its efficiency, including adjustments for overpayments resulting from the risk-adjustment system and discontinuing the quality bonus demonstration; and alternative payment models that would introduce competitive pricing to the MA program.


Marsha Gold, ScD (bio)
Senior Fellow
Mathematica Policy Research, Inc.

James Cosgrove, PhD (bio)
Director, Health Care
U.S. Government Accountability Office

Robert Coulam, JD, PhD (bio)
Senior Lecturer
Center for Health Policy Research
Simmons College School of Management

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