Health Affairs July 6, 2017
Similar to private health insurance, there is little competition in Medicare Advantage (MA). The US District Court’s recent decision against the Aetna-Humana merger is a strong signal that the current Medicare Advantage market does not favor new entry. According to the Justice Department’s expert testimony in the case, only 5.5 percent of the 284 complaint counties experienced new entry from 2012 to 2016 from plans that were not either Humana or Aetna.
Yet Medicare Advantage does not have to be constrained in this way. Innovative provider groups have shown it is possible to launch an MA plan even when it may not be possible to launch a commercial insurance product. As provider groups gain experience through accountable care models, the...
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