title: Medicare Advantage Members' Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services.
abstract: Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans' expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.
authors.affiliation: Laura M. Keohane is a doctoral candidate in the Department of Health Services, Policy, and Practice at the School of Public Health, Brown University, in Providence, Rhode Island.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Keohane
authors.affiliation: Regina C. Grebla is a researcher in the School of Public Health at Brown University and associate director in the Global Health Economics, Outcomes Research, and Epidemiology Division at Shire in Lexington, Massachusetts.
authors.forename: Regina C
authors.initials: RC
authors.lastname: Grebla
authors.affiliation: Vincent Mor is the Florence Pirce Grant Professor of Community Health in the Department of Health Services, Policy, and Practice at the School of Public Health, Brown University, and a research health scientist at the Providence Veterans Affairs (VA) Medical Center.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Amal N. Trivedi (amal_trivedi@brown.edu) is an associate professor in the Department of Health Services, Policy, and Practice at the School of Public Health, Brown University, and an investigator in the Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017047:Cost Sharing / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D008297:Male; D020398:Medicare Part C / Q000191:economics*; D012866:Skilled Nursing Facilities / Q000191:economics*; D014481:United States
keywords: Access To Care; Cost of Health Care; Managed Care - Medicare < Managed Care