Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance

More and more Medicare beneficiaries are enrolling each year in Medicare Advantage (MA), but experts knew little about their physician reimbursement differences or similarities. A new study by Erin Trish, Paul Ginsburg, and Laura Gascue finds MA plans pay physicians prices that are similar to traditional Medicare rates.

For the study published on July 10 in JAMA Internal Medicine, Trish and her colleagues analyzed a sample of 144 million Medicare, MA, and commercial claims filed from 2007 to 2012 in metropolitan areas. They compared reimbursement rates for 11 common procedures, from a doctor’s visit to a colonoscopy, and found that the mean MA reimbursement rate nearly matched the traditional Medicare rate in many cases. For example, the mean rate for an office visit in MA was 97 percent of the traditional Medicare rate. Medicare Advantage’s mean reimbursement rate ranged from 91 percent of traditional Medicare’s rate for the physician fee for a cataract removal in an ambulatory surgery center to 102 percent of traditional Medicare for a complex emergency department visit.

The researchers concluded that traditional Medicare rates appear to anchor the prices paid by Medicare Advantage.

The full study is available at JAMA Internal Medicine. The press release about the study is available here.

Citation: Trish, E., Ginsburg, P., Gascue, L., & Joyce, G. (2017). Physician reimbursement in Medicare Advantage compared with traditional Medicare and commercial health insurance. JAMA internal medicine177(9), 1287-1295.