Competition and health plan quality in the Medicare Advantage market

Abstract

Objective To examine the relationship between insurer market structure, health plan quality, and health insurance premiums in the Medicare Advantage (MA) program. Data Sources/Study Setting Administrative data files from the Centers for Medicare and Medicaid Services, along with other secondary data sources. Study Design Trends in MA market concentration from 2008 to 2017 are presented, alongside logistic and linear regression models examining MA plan quality and premiums as a function of insurer market structure for 2011. Data Collection/Extraction Methods Data are publicly available. Principal Findings MA plans that tend to operate in more concentrated MA markets have a higher predicted probability of receiving a high‐quality health plan rating. Operating in more concentrated MA markets was also found to be associated with higher premiums. Among plans that tend to operate in very concentrated MA markets, high‐quality MA plans were associated with premiums as much as two times higher than premiums associated with lower‐quality plans. Conclusions Any policies directed at enhancing insurer competition should consider implications for health plan quality, which may be very different than the implications for enrollee premiums.

Restrictiveness of Medicare Advantage provider networks across physician specialties

“…Recent trends with respect to the increased use of telehealth across all insurance markets may be an important part of the solution 19 . Similarly, our finding that more concentrated MA markets have more restrictive networks illustrates potential harm from the relatively concentrated nature of MA markets 20 …”

“…19 Similarly, our finding that more concentrated MA markets have more restrictive networks illustrates potential harm from the relatively concentrated nature of MA markets. 20 Second, our results underscore the importance of improving the accuracy of provider network data and developing alternative measures of network restrictiveness. Prior work relying on provider directories, 4 for instance, found that cardiology networks were narrower than other specialties, contrary to our results.…”