It is appropriate when the enrollee
is given a choice between higher- and lower-cost options.
Under the plan's guidelines each enrollee
was required to choose a group practice affiliated with the plan and to choose a primary care physician (family physician, internist, pediatrician, or obstetrician-gynecologist) at or before the time of first utilization of care under the plan.
Kaiser Permanente, a big managed care company, might have to pay an average of about $32 per month per enrollee
, or a total of $355 million, into the program because of its own enrollees
' lack of obvious chronic conditions.
Paying extra cash to insurers with enrollees
who have big claims.
Eligible MA plans in these states, upon CMS approval, may offer varied plan benefit designs for enrollees
who fall into certain clinical categories identified and defined by CMS.
MEDICARE ADVANTAGE plans with relatively low premiums and high levels of cost-sharing ended up with healthier enrollees
in 2008 than did other Medicare Advantage plans, the U.
Thus, the pre-SCHIP experiences of the recent enrollee
sample serve as a counterfactual for the SCHIP experiences of the established enrollee
A CDHP is a high-deductible health plan coupled with a savings account enrollees
use to pay for health care.
Once it is determined that the enrollee
appears in both the MSIS and EDB data sets, it is necessary to determine if the enrollee
was eligible for both programs at the same time.
The GAO found one Medicare fee-for-service enrollee
who ran up $3.
Through these changes, CMS seeks to support benefit flexibility and efficiency that allows Medicare enrollees
to choose the care that best fits their health needs.
Second, we find that the enrollees
in the program tended to be not only older but also relatively sick, suggesting that the cost per enrollee
of the ACA expansions may be greater than expected.
We find that new enrollees
had first-month claims experience that was nearly $29 lower per enrollee
than that for those who were continuously enrolled.
Public health insurance exchanges and issuers of "qualified health plan" (QHP) coverage can decide for themselves whether to release their first batch of official federal enrollee
experience survey results.
Throughout the history of Medicaid, little has been known about cross-state enrollee