Medicare Advantage: Special Needs Plans Were More Profitable, on Average, than Plans Available to All Beneficiaries in 2011

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Correspondence issued by the Government Accountability Office with an abstract that begins "Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-level median profit margin compared to MA plans available to all beneficiaries--7.1 percent vs. 3.2 percent. All three types of SNPs--dual-eligible SNPs, chronic condition SNPs, and institutional SNPs--spent, on ... continued below

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United States. Government Accountability Office. December 19, 2013.

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Correspondence issued by the Government Accountability Office with an abstract that begins "Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-level median profit margin compared to MA plans available to all beneficiaries--7.1 percent vs. 3.2 percent. All three types of SNPs--dual-eligible SNPs, chronic condition SNPs, and institutional SNPs--spent, on average, a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries. SNPs also spent a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries after accounting for whether a plan had a high or low enrollment-weighted average benchmark--the maximum amount Medicare will pay plans to serve an average beneficiary in a given area. Similarly, SNPs spent a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries after accounting for plan type (i.e., health maintenance organizations and preferred provider organizations). Further, these differences persisted, on average, after excluding SNPs located in Puerto Rico from the overall SNP analysis and the analyses that accounted for benchmarks and plan type. The MA market in Puerto Rico has some unusual characteristics, such as having benchmarks that are substantially higher relative to Medicare fee-for-service (FFS) than other areas of the United States."

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Government Accountability Office Reports

The U.S. Government Accountability Office (GAO) is an independent, nonpartisan agency that works for the U.S. Congress investigating how the federal government spends taxpayers' money. Its goal is to increase accountability and improve the performance of the federal government. The Government Accountability Office Reports Collection consists of over 13,000 documents on a variety of topics ranging from fiscal issues to international affairs.

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  • December 19, 2013

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  • June 12, 2014, 7:50 p.m.

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United States. Government Accountability Office. Medicare Advantage: Special Needs Plans Were More Profitable, on Average, than Plans Available to All Beneficiaries in 2011, text, December 19, 2013; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc301949/: accessed September 24, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.