About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

GAO-09-132R 1 (2008-12-08)

handle is hein.gao/gaobaanle0001 and id is 1 raw text is: im Am,GA 0 T E IAccountability * Integrity * Reliability United States Government Accountability Office Washington, DC 20548 December 8, 2008 The Honorable Pete Stark Chairman Subcommittee on Health Committee on Ways and Means House of Representatives Subject: Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2006 Dear Mr. Chairman: The federal government's spending on the Medicare Advantage (MA) program has grown substantially in recent years, from approximately $60 billion in 2006 and $77 billion in 2007 to an estimated $91 billion in 2008.' MA organizations provide health care coverage to Medicare beneficiaries through private health plans, thus offering an alternative to the original Medicare fee-for-service (FFS) program.2 Payments to MA organizations are, in part, based on the projected expenditures organizations submit in their bids for providing Medicare-covered services, as well as actual enrollment and beneficiary health status. Once Medicare payments are determined, they are not modified based on differences between actual and projected expenses.3 MA organizations are not required to submit claims data to the Centers for Medicare & Medicaid Services (CMS)-the agency that administers Medicare-but they must report actual expenditures for the year 2 years prior to the upcoming contract year. For example, MA organizations reported their actual 2006 expenditures in their bid submission for contract year 2008. When MA organizations submit their bids, the actual expenditures reported in their bid submissions reflect the MA organizations' most recent full calendar year of actual expenditure data. 'Statement of Peter R. Orszag, Congressional Budget Office, The Medicare Advantage Program: Enrollment Trends and Budgetary Effects, testimony before the Senate Committee on Finance, April 11, 2007. 2Medicare is the federally financed health insurance program for persons aged 65 and over, certain individuals with disabilities, and individuals with end-stage renal disease. Medicare Part A covers hospital and other inpatient stays. Medicare Part B is optional insurance, and covers hospital outpatient, physician, and other services. Medicare Parts A and B are known as original Medicare or Medicare FFS. Medicare beneficiaries have the option of obtaining coverage for Medicare Parts A and B services from private health plans that participate in Medicare's MA program-also known as Medicare Part C. All Medicare beneficiaries are eligible for coverage for outpatient prescription drugs under Medicare Part D. 3However, payments to MA organizations may be modified based on differences in actual and projected beneficiary health status, beneficiary residence, and enrollment. Actual expenses may be used to inform projections for future contract years. GAO-09-132R Medicare Advantage Expenses

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most