Study: Private Plans May Trump Medicare At Controlling Costs.

Study: Private Plans May Trump Medicare At Controlling Costs.

The Hill (12/8, Millman) reports, "Private insurance plans might be better at controlling healthcare costs than Medicare, according to a Health Affairs study released Tuesday morning." Notably, the "study followed up on an influential 2009 New Yorker article that found Medicare spending on the elderly population is significantly higher in McAllen, Texas, than it is in El Paso, Texas. Using medical and expense data for patients in those towns who are privately insured by Blue Cross and Blue Shield, researchers found private insurers were cheaper and had a more consistent cost structure."

        CQ HealthBeat (12/8, Adams, subscription required) reports, "The new study cannot explain definitively why differences in health care spending are lower under private coverage, but the authors suggest that mechanisms for utilization review and management used by private insurers could play a big role." They also "said the most probable explanation is based on which payers are better at controlling costs in areas where legitimate medical judgments can vary. Medicare exercises very little utilization management, but private insurers can be much more aggressive about controlling services."

        Modern Healthcare (12/8, Vesely, subscription required) reports that according to lead study author Luisa Franzini, "For a number of reasons, insurers generally are reluctant to intrude on medical decision-making. ... But the fact that these utilization management mechanisms exist may prompt some physicians who might otherwise overuse certain services to exercise more restraint."

        NPR (12/8, Rau) notes in its Shots blog, "The new study analyzed claims from 65,701 Blue Cross members in McAllen's Hildago County and 66,657 members in El Paso. Blue Cross spent $2,266 on the average McAllen enrollee, compared to $2,428 on the average El Paso enrollee." In "contrast, Medicare spent an average of $14,817 per patient in McAllen -- 86 percent above the $7,947 it spent on an average El Paso enrollee, according to the study." The Washington D.C. Examiner

2011 Medicare Premiums and Deductibles

Overview

The Centers for Medicare and Medicaid Services (CMS) has set the Medicare premiums, deductibles and coinsurance amounts to be paid by Medicare beneficiaries in 2011.

Medicare Part A deductible and coinsurance

For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,132 in 2011, an increase of $32 from this year's $1,100 deductible. The Part A deductible is the beneficiary's cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. ·   Beneficiaries must pay an additional $283 per day for days 61 through 90 in 2011, and ·   $566 per day for hospital stays beyond the 90th day in a benefit period. For 2010, the per-day payment for days 61 through 90 was $275, and $550 for beyond 90 days. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $141.50 in 2011, compared to $137.50 in 2010. Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. All of these Part A program payment changes are determined in accordance with a statutory formula.

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