Journal article
Insurance Coverage and Health Care Spending
The American journal of managed care, v 28(4)
01 Apr 2022
PMID: 35420745
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVES: Medigap protects traditional Medicare (TM) beneficiaries against catastrophic expenses. Federal regulations around Medigap enrollment and pricing are limited to the first 6 months after turning 65 years old. Eight states institute regulations that apply to later enrollment; half use community rating (charging everyone the same premium) and half use both community rating and guaranteed issue (requiring insurers to accept any beneficiary irrespective of health conditions). We examined the impact of state-level Medigap regulations on insurance coverage and health care spending for Medicare beneficiaries. STUDY DESIGN: We used a retrospective cohort study design. Using the 2010-2016 Medicare Current Beneficiary Survey, we identified beneficiaries with TM only, TM + Medigap, or Medicare Advantage (MA) by state-level Medigap regulations. METHODS: Outcomes were insurance coverage and health care spending. We used an instrumental variable approach to address endogenous insurance choice. We conducted 2-stage least squares regression while controlling for individual-level characteristics and area-level demographic characteristics. Then we used the recycled prediction methods to predict enrollment and spending outcomes for the 3 state-level Medigap regulation scenarios. RESULTS: Although enrollment in TM only was consistent across regulation scenarios, the scenario with community rating and guaranteed issue had lower Medigap enrollment and higher MA enrollment than the no-regulation scenario. Despite negligible health differences, TM + Medigap beneficiaries had higher Medicare spending than TM-only beneficiaries, suggesting moral hazard. CONCLUSIONS: Our findings suggest a link between additional regulations and lower Medigap and higher MA enrollment. Policy makers should consider the potential effects on insurance coverage, premiums, financial protection, and moral hazard when designing Medigap regulations.
Metrics
Details
- Title
- Insurance Coverage and Health Care Spending
- Creators
- Sungchul Park - Drexel UniversityNorma B. Coe - Univ Penn, Dept Med Eth & Hlth Policy, Perelman Sch Med, Philadelphia, PA 19104 USA
- Publication Details
- The American journal of managed care, v 28(4)
- Publisher
- Managed Care & Healthcare Communications Llc
- Number of pages
- 11
- Grant note
- R01 AG049815 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000789655100001
- Scopus ID
- 2-s2.0-85128291507
- Other Identifier
- 991019167611904721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Health Care Sciences & Services
- Health Policy & Services