Description: This article compares the Prescription Drug Plan (PDP) market to the commercial individual market exchanges included in the Affordable Care Act. PDP carrier actions to date could help predict certain aspects of the exchange market.

Description: Issue No. 36. Issues relating to Provider Sponsored Organizations PSOs contracting with HCFA to sponsor Medicare + Choice. Article discusses revenue and the addition of non-Medicare covered benefits.

Description: This article discusses the legislative summary of the changes that will occur with the new Medigap policies, which will be effective on or after June 1, 2010. Issue No 60

Description: Two Medicare risk funding provisions that were radically changed by the BBA of 1997 funding variations by geographic area and risk adjustment. Issue No. 36

Description: This article takes a closer look at Medicare Part D Coverage and the types of payment demonstration payment of the federal reinsurance amountFlexible Capitation, Fixed Capitation, MA Rebate. Issue No 60

Description: A proposal to reform current health care market, from a 'preferred payer' system, in which Medicare and Medicaid pay less than the true cost while others must then pay more, to a 'value for money' system. This would be achieved by requiring providers to bill all patients the same rate for the same services, with a standard bundling format to make all providers' rate differences transparent. Differences between billed charges and what Medicare pays would be made up by the Medicare patient, rather than subsidized by those outside of Medicare.

Description: Discussion of Medicare's Ambulatory Payment Classification APC system as the standard for reimbursement of non-capitated outpatient hospital services with sample calculations. Issue No. 37.

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: This article discusses planning for the changes that will occur with the new Medigap policies, which will be effective on or after June 1, 2010. Issue No. 60

Description: This article focuses on the capitation rate development methodology for the Medicare-Medicaid Financial Alignment Demonstration. It also describes the background behind the establishment of the initiative and how it will be evaluated.