Health care costs (11 - 20 of 138 items)
Medicare Advantage: Enrollment Increased from 2010 to 2011 while Premiums Decreased and Benefit Packages Were Stable
GAO-12-93: Published: Oct 31, 2011. Publicly Released: Nov 30, 2011.
Enrollment and spending in Medicare Advantage (MA) plans--the private plan alternative to the Medicare fee-for- service (FFS) program--have more than doubled since 2004. MA plans generally receive larger payments from Medicare than what these plans would require to provide the original Medicare FFS benefit package. Plans must use this additional money to reduce cost sharing, reduce premiums, and o...
Private Health Insurance: Early Indicators Show That Most Insurers Would Have Met or Exceeded New Medical Loss Ratio Standards
GAO-12-90R: Published: Oct 31, 2011. Publicly Released: Nov 30, 2011.
To help ensure that millions of Americans who rely on private insurance for health care coverage receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of insurance premium revenues health insurers spent on...
Private Health Insurance: Implementation of the Early Retiree Reinsurance Program
GAO-11-875R: Published: Sep 30, 2011. Publicly Released: Oct 31, 2011.
During the last decade the number of large employers offering health benefits to retirees--including early retirees not eligible for Medicare--has declined. Among all large firms that offered health benefits to active employees from 2001 to 2010, the percentage that offered health benefits to retirees decreased from 39 percent in 2001 to 28 percent in 2010. According to the Agency for Healthcare R...
Private Health Insurance: Early Experiences Implementing New Medical Loss Ratio Requirements
GAO-11-711: Published: Jul 29, 2011. Publicly Released: Aug 29, 2011.
To help ensure that Americans receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for health insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of premiums spent on medical claims. The PPACA MLR is defined differently from the traditional MLR. Beginning in 2...
Consumer-Directed Health Plans: Health Status, Spending, and Utilization of Enrollees in Plans Based on Health Reimbursement Arrangements
GAO-10-616: Published: Jul 16, 2010. Publicly Released: Aug 16, 2010.
Consumer-directed health plans (CDHP) combine a high-deductible health plan with a tax-advantaged account, such as a health reimbursement arrangement (HRA), that enrollees can use to pay for health care expenses. In an effort to restrain cost growth, several employers, including the federal government through its Office of Personnel Management (OPM), have offered HRAs for several years. For enroll...
Medicaid and CHIP: Enrollment, Benefits, Expenditures, and Other Characteristics of State Premium Assistance Programs
GAO-10-258R: Published: Jan 19, 2010. Publicly Released: Jan 19, 2010.
Fiscal pressures, rising health care costs, and increases in the number of uninsured may lead states to look toward public-private partnerships to help finance health insurance coverage. Through Medicaid and the State Children's Health Insurance Program (CHIP), states have had long-standing authority to operate premium assistance programs that subsidize the purchase of private health insurance. En...
VA Health Care: Ineffective Medical Center Controls Resulted in Inappropriate Billing and Collection Practices
GAO-10-152T: Published: Oct 15, 2009. Publicly Released: Oct 15, 2009.
GAO was asked to testify on billing practices of the Department of Veterans Affairs (VA). GAO previously reported that continuing problems in billing and collection processes at VA impaired its ability to maximize revenue from private insurance companies (third-party insurers). In June 2008, GAO reported on its follow-up review that (1) evaluated VA billing controls, (2) assessed VA-wide controls...
Private Health Insurance: Research on Competition in the Insurance Industry
GAO-09-864R: Published: Jul 31, 2009. Publicly Released: Aug 31, 2009.
Health care providers and members of Congress have raised concerns that consolidation in the private health insurance industry may be resulting in less competitive markets and contributing to rising health insurance rates paid by consumers and employers. However, measuring the extent of changes in market competition over time or the effects of changes is challenging. In particular, reliable, longi...
Health Insurance: Enrollment, Benefits, Funding, and Other Characteristics of State High-Risk Health Insurance Pools
GAO-09-730R: Published: Jul 22, 2009. Publicly Released: Aug 21, 2009.
A growing number of states--35 as of June 2009--have created high-risk health insurance pools (HRPs) primarily to provide coverage to individuals whose health status limits their access to coverage in the private individual health insurance market. HRPs--typically state-run nonprofit associations--often contract with a private health insurance carrier to administer the pool and offer a range of he...
State Children's Health Insurance Program: CMS Should Improve Efforts to Assess whether SCHIP Is Substituting for Private Insurance
GAO-09-252: Published: Feb 20, 2009. Publicly Released: Mar 23, 2009.
Congress created the State Children's Health Insurance Program (SCHIP) to reduce the number of uninsured children in low-income families that do not qualify for Medicaid. States have flexibility in structuring their SCHIP programs, and their income eligibility limits vary. Concerns have been raised that individuals might substitute SCHIP for private health insurance--known as crowd-out. GAO was as...