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APHA Scientific Session and Event Listing

Nathan West, MPA¹, Shulamit L. Bernard, PhD², Leslie Greenwald, PhD¹, Elisabeth Root, MA¹, and Colleen Spagnardi, BA¹. (1) Health Services and Social Policy Research, RTI International, 3040 Cornwallis Road, Durham, NC 27709, 919-541-6816, nathanwest@rti.org, (2) Program on Health Care Quality and Outcomes, RTI International, P. O. Box 12194, Research Traingle Park, NC 27709

Data derived from a 2004 mail survey with telephone follow-up of Medicare beneficiaries enrolled in PPO demonstration plans. The stratified random sample of 35 PPO demonstration service areas also included HMO and Original Medicare enrollees as comparison groups. Overall response rate was 67% with 20,304 respondents.

We found that relatively few Medicare beneficiaries recognized the terms PPO and Point-of-Service (POS), but some variation did exist across the demonstration markets. For example, PPO enrollees in Arizona markets (71 percent) reported relatively high awareness of the plan types, whereas PPO/POS enrollees in New Jersey markets (26 percent) reported low recognition and looked more comparable to Original Medicare beneficiaries' awareness (25 percent). Findings also include a discussion of respondent scores on an objective knowledge index that examines awareness of key features of PPOs.

We also found that exclusive of monthly premiums, a larger proportion of PPO enrollees reported $1 - $1,000 in out-of-pocket expenses in the last 6 months compared to HMO enrollees and OM beneficiaries. In contrast, Original Medicare beneficiaries in many markets – particularly in New Orleans, New York and Indiana markets – incurred the greatest proportion of out-of-pocket expenses that exceeded $1,000.

Regarding issues of plan choice and satisfaction, we found little variation in responses on measures of access to care. However, PPO enrollees across the demonstration markets reported lower satisfaction ratings of their overall health insurance coverage as compared to HMO enrollees and beneficiaries in Original Medicare.

Learning Objectives:

• To examine Medicare beneficiary awareness of plan options, reasons for plan choice and plan experience among enrollees in demonstration preferred provider organizations (PPOs) compared to enrollees of HMOs or Original Medicare. We give particular attention to demonstration markets in which there is statistically significant variation of health care experiences by plan type.

Keywords: Medicare, Member Surveys

Presenting author's disclosure statement:

Not Answered