Skip to main content

Medicare Managed Care: Payment Rates, Local Fee-for-Service Spending, and Other Factors Affect Plans' Benefit Packages

HEHS-99-9R Published: Oct 09, 1998. Publicly Released: Oct 09, 1998.
Jump To:
Skip to Highlights

Highlights

Pursuant to a congressional request, GAO provided information on Medicare's health maintenance organizations (HMO), focusing on: (1) the key differences between Medicare's traditional fee-for-service (FFS) and managed care programs; (2) how Medicare historically set the monthly capitation rates paid to managed care plans and why these rates varied among counties; (3) how the Balanced Budget Act of 1997 (BBA) affected rates and the rate-setting process; (4) how the Health Care Financing Administration (HCFA) approves managed care plans' benefits and premiums; and (5) what requirements HCFA places on plans to notify beneficiaries about impending benefit and premium changes.

Full Report

Office of Public Affairs

Topics

Comparative analysisHealth care costsHealth care programsHealth insurance cost controlHealth maintenance organizationsManaged health careMedical services ratesMedicareCapitation (medical care)Beneficiaries