Preferred Pharmacies in Medicare Part D

Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does this work? A paper by Xu et al. (2022) aims to answer this question using 2011-2016 data. that compares Low Income Subsidy (LIS) Medicare beneficiaries and non-LIS beneficiaries. LIS beneficiaries…

When is full health insurance not optimal

In many markets, however, we observe that lower income individuals do not purchase the most generous forms of health insurance. For instance, despite the passage of the Affordable Care Act–which provided subsidies to lower income individuals to purchase relatively generous insurance–some individuals preferred the less generous Association Health Plans (AHPs) also known as “skinny” health…

Are high-deductible plans the best choice?

For many individuals with employer-provided health insurance, a recent paper by Liu and Sydnor (2022) find that this is indeed the case. The authors use data from the 2011-2016 Kaiser Family Foundation (KFF) Employer Health Benefits Survey (EHBS). The authors examine the maximum out-of-pocket cost (including both premiums and maximum cost-sharing) as well as whether…

Who pays more for hospital and physician services: commercial payers, Medicare or Medicaid? And how much more?

Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…

No surprise bills?

In a February 10th speech, President Biden wanted to end surprise bills for patients. Specifically he said: No more surprise billing.  No more. In fact, he proposed the No Surprises Act. Key questions you may have include: what is a surprise bill? are there any exceptions to this rule? Kaiser Health News has a nice…