Why do so few HMOs offer Medicare risk plans in rural areas?
Serrato, Carl A
Date of Pub
Bergeron, Jeanette W; Brown, Randall S
Only 17 of the 38 health maintenance organizations (HMOs) that have Medicare risk contracts and offer coverage to commercial
clients in rural counties include the rural counties in their Medicare plan service areas. Rural counties in which HMOs offer
Medicare coverage have higher average adjusted average per capita costs (AAPCCs), larger populations, and more physicians
per capita than rural counties excluded by risk plans. Interviewed plans cite low and erratic AAPCCs, scarcity of potential
enrollees, lack of negotiating power with physicians, and adverse selection as drawbacks in rural areas. Proposed changes
to the payment methodology would probably lead HMOs to increase their Medicare offerings in urban fringe areas, but not in
isolated rural areas.
Capitation Fee : Actuarial Analysis : Aged : Catchment Area (Health) : Health Maintenance Organizations/economics/organization
& administration/statistics & numerical data : Health Services for the Aged : Human : Medicare/organization & administration/statistics
& numerical data : Program Evaluation : Risk : Rural Health Services/economics/organization & administration/statistics &
numerical data : Support, U.S. Gov't, Non-P.H.S. : United States