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Medicare’s Clout Wanes as Private Health Plans Poach Enrollees

April 15, 2019, 9:35 AM

Traditional Medicare is losing enrollees and political support to a programmatic frenemy: the private health plans that cover a third of Medicare participants.

These Medicare Advantage plans receive a fixed amount per enrollee to provide benefits rather than a per-service payment rate. That means the plans have more incentive than physicians in traditional Medicare to provide efficient, cost-saving treatment. But longstanding cost and quality questions about Medicare Advantage plans raise concerns about federal efforts to expand their role in a restructured Medicare program focused on value-based medicine.

“We’re lacking a lot of information about the experience of beneficiaries in Medicare ...