医疗补助条例为受益人提供保护,特别是在健康冲击后,但可能会提高保险费
Jingwei Sun1, Michael E Chernew2, J Michael McWilliams3
1Jingwei Sun (sun@hcp.med.harvard.edu), Harvard University, Boston, Massachusetts.
Health affairs (Project Hope)
|July 7, 2025
概括
在改变计划时,Medigap法规保护患有严重疾病的受益人免受医疗承保. 拥有这些保护的国家在健康冲击的人群中出现了更高的退学率,这表明计划选择的增加.
科学领域:
- 卫生政策 卫生政策
- 卫生经济学 卫生经济学
- "保险条例"中的保险条例.
背景情况:
- 医疗保险受益者在从医疗保险优势计划切换到Medigap计划时可能面临医疗承销.
- 担保发行和社区评级法规旨在保护受益人免受不利的承保.
- 健康冲击,例如新的严重疾病诊断,可能会影响受益人改变计划的能力.
研究的目的:
- 评估Medigap保证发行和社区评级法规对受益人退出Medicare Advantage的影响.
- 评估这些法规是否不成比例地有利于遭受健康冲击的受益者.
主要方法:
- 对2015-2019年期间20%的医疗保险受益者随机抽样进行分析.
- 在有和没有既有保证发行和社区评级法规的州的退学率的比较.
- 根据受益人的健康冲击状态对分析的分层.
主要成果:
- 患有健康冲击的受益人更有可能在拥有两种Medigap法规的国家 (2.75%) 与没有两种法规的国家 (1.42%) 相比,更有可能退出Medicare Advantage.
- 没有健康冲击的受益人显示,有和没有这些规定的国家之间的退学率差异较小 (1.49%对1.28%).
结论:
- 医疗保障法规似乎有助于健康冲击的受益人过渡,提供医疗承保的保护.
- 这些法规的整体好处包括平衡高风险个人的保护与低风险受益人的潜在保费增加.
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