Medicare Demonstration PPOs


Book Description

Preferred provider org. (PPO) are more prevalent than other types of health plans, but, in 2003, only 6 PPOs contracted to serve Medicare beneficiaries (BE) in Medicare+Choice. The Centers for Medicare & Medicaid Services (CMS) initiated 2 demonstrations that include a total of 34 PPOs. This study: (1) describes how CMS used its statutory authority to conduct the 2 demo's., (2) assessed the extent to which demo. PPOs (DP) expanded access to Medicare health plans & attracted enrollees, (3) compared CMS's est. of out-of-pocket costs that BE incurred in DP with those of other types of coverage, incl. fee-for-service Medicare, M+C plans, & Medigap policies, & (4) determined the effects of DP on Medicare spending. Charts & tables.




The Medicare Handbook


Book Description







Improving the Medicare Market


Book Description

Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.




Section 1557 of the Affordable Care Act


Book Description

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.







Status Report


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