The report, Average Out-of-Pocket Health Care Costs for Medicare+Choice Enrollees Increase Ten Percent in 2003, also reveals that out-of-pocket spending for enrollees in Medicare PPO (preferred provider organization) demonstration plans is nearly 50 percent higher, on average, than costs for Medicare+Choice enrollees. Average out-of-pocket spending by PPO enrollees is also higher than that experienced by the average beneficiary in traditional Medicare--raising questions about whether these plans can offer a lower-priced alternative for Medicare beneficiaries, according to authors Marsha Gold and Lori Achman of Mathematica Policy Research, Inc.

Gold and Achman estimate that enrollees in PPO demonstration plans, which were implemented by the Centers for Medicare and Medicaid Services in 2003 to give Medicare+Choice enrollees more plan options, will spend $2,884 out-of-pocket in 2003. That is substantially higher than the $1,964 in average annual costs for those in Medicare+Choice plans. These cost estimates are potentially understated because they assume that all care is received through in-network providers, according to the report.

Costs for enrollees in Medicare+Choice have continued to trend upward since 1999, the first year Gold and Achman analyzed beneficiary spending in the Medicare+Choice program. In 2003, enrollees will pay an average of $1,964 in out-of-pocket expenses for health care--twice as high as in 1999, when costs averaged $976. "As Congress debates the role of private plans in the future of the Medicare program, it should consider the eroding financial protection experienced under Medicare+Choice," said Gold.

Sicker Medicare+Choice enrollees face ev
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
11-Aug-2003