Estimating the Medicare+Choice Threshold Payment Rate

Funder:	Office of Rural Health Policy (ORHP)
Research center:	Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Phone: 402.559.5260
Lead researcher:	Timothy D. McBride, PhD , 314.935.4356, tmcbride@wustl.edu
Project completed:	August 2001
Topics:	Health care financing Medicare

This analysis will use an empirical model to estimate the threshold payment rate firms need, all else equal, to enter the Medicare managed care market in a given county. By comparing this threshold rate with the rate currently paid by the county, we will use the model to explain empirically why Medicare+Choice (M+C) enrollment growth has been slow in rural areas. We expect that counties where the M+C capitation rate is currently below this threshold will have no enrollment. Furthermore, we can use the threshold payment rate (TPR) to compute a county-level "gap" in the M+C rates, that is, a difference between what the rate currently is (M+C rate), and what it would need to be to attract enrollment, given the county s characteristics (GAP = TPR - M+C rate).

Publications

• Update on Medicare+ Choice: Rural Medicare Beneficiaries Enrolled in Medicare+ Choice Plans through September 2001
  Author(s): Timothy McBride, Courtney Andrews, Alexie Makarkin, Keith Mueller
  Report Number: PB 2002-4
  Date: 08 / 2002
  Medicare+ Choice Plans, counties enrolled, and data available