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Medicare’s Future: Current Picture, Trends, and Medicare Prescription Drug Improvement & ... - page 25 / 60

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Risk and Payment Issues

Expensive for Medicare program because of favorable risk selection and payment rules

Incentives to “cream skim” and avoid risk

Overall Failure to Date

Private plans do not participate in many states and geographic areas

Wide geographic variability in premiums and benefits

Unstable participation by private plans and providers

High out-of-pocket burden on sick

No standard benefit; impossible to compare plan benefits

Medicare+Choice: Lessons

Source: Geraldine Dallek, Brian Biles, and Lauren Nicholas, Lessons from Medicare+Choice for Medicare Reform, The Commonwealth Fund, June 2003.

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