We estimate the economic surplus created by Medicare Advantage under its reformed competitive bidding rules. We use data on the universe of Medicare beneficiaries, and develop a model of plan bidding that accounts for both market power and risk selection. We find that private plans have costs around 12% below fee-for-service costs, and generate around $50 dollars in surplus on average per enrollee-month, after accounting for the disutility due to enrollees having more limited choice of providers. Taxpayers provide a large additional subsidy, and insurers capture most of the private gains. We use the model to evaluate possible program changes.

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健康保险竞争能否奏效？来自 Medicare Advantage 的证据

我们估计 Medicare Advantage 在其改革后的竞标规则下创造的经济盈余。我们使用关于医疗保险受益人范围的数据，并开发了一个计划投标模型，该模型考虑了市场力量和风险选择。我们发现，私人计划的成本比按服务付费的成本低 12% 左右，并且在考虑到由于注册者对提供商的选择更加有限而导致的无效性之后，每个注册者每月平均产生约 50 美元的盈余。纳税人提供大量额外补贴，保险公司获得大部分私人收益。我们使用该模型来评估可能的程序更改。