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HKS Authors

See citation below for complete author information.

John D. MacArthur Professor of Health Policy and Management, HKS and HSPH; Professor of Health Care Policy, HMS

Abstract

Within Medicare, the Medicare Advantage program has historically attracted better risks—healthier, lower-cost patients—than has traditional Medicare. The disproportionate enrollment of lower-cost patients and avoidance of higher-cost ones during the 1990s—known as favorable selection—resulted in Medicare’s spending more per beneficiary who enrolled in Medicare Advantage than if the enrollee had remained in traditional Medicare. We looked at two measures that can indicate whether favorable selection is taking place—predicted spending on beneficiaries and mortality—and studied whether policies that Medicare implemented in the past decade succeeded in reducing favorable selection in Medicare Advantage. We found that these policies—an improved risk adjustment formula and a prohibition on monthly disenrollment by beneficiaries—largely succeeded. Differences in predicted spending between those switching from traditional Medicare to Medicare Advantage relative to those who remained in traditional Medicare markedly narrowed, as did adjusted mortality rates. Because insurance exchanges set up under the Affordable Care Act will employ similar policies to combat risk selection, our results give reason for optimism about managing competition among health plans.

Citation

Newhouse, Joseph P., Jie Huang, Mary Price, J. Michael McWilliams, and John Hsu. "Steps To Reduce Favorable Risk Selection In Medicare Advantage Largely Succeeded, Boding Well For Health Insurance Exchanges." Health Affairs 31.12 (December 2012): 2618-2628.