Health Affairs May 23, 2024
Brian C. DeBusk, Brian J. Miller, Craig Samitt, Kenny Kan

The Medicare program represents a sacred promise to America’s elderly and disabled citizens. The Medicare Fee-For-Service (FFS) program, introduced as part of the Great Society in 1965 to mirror a Blue Cross Blue Shield commercial market standard, covered hospital and physician benefits separately. As the private health care market evolved, policymakers introduced private plans into Medicare, followed by the Medicare Risk Program and the integration of health maintenance organizations, eventually leading to today’s Medicare Advantage (MA) program.

This article addresses the history of the Medicare program and the current debate around the recent MedPAC estimate of MA overpayments. We propose nuanced analytical considerations to ensure accurate coding, address favorable selection, and foster a holistic policy future for Medicare.

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Topics: CMS, Congress / White House, Govt Agencies, Insurance, Medicare, Medicare Advantage, Patient / Consumer, Provider
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