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Medicare Part D: Are Insurers Gaming the Low Income Subsidy Design?

Author

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  • Francesco Decarolis

Abstract

This paper shows how in Medicare Part D insurers' gaming of the subsidy paid to low-income enrollees distorts premiums and raises the program cost. Using plan-level data from the first five years of the program, I find multiple instances of pricing strategy distortions for the largest insurers. Instrumental variable estimates indicate that the changes in a concentration index measuring the manipulability of the subsidy can explain a large share of the premium growth observed between 2006 and 2011. Removing this distortion could reduce the cost of the program without worsening consumer welfare. (JEL G22, H51, I13, I18)

Suggested Citation

  • Francesco Decarolis, 2015. "Medicare Part D: Are Insurers Gaming the Low Income Subsidy Design?," American Economic Review, American Economic Association, vol. 105(4), pages 1547-1580, April.
  • Handle: RePEc:aea:aecrev:v:105:y:2015:i:4:p:1547-80
    Note: DOI: 10.1257/aer.20130903
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    Citations

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    Cited by:

    1. Sonia P. Jaffe & Mark Shepard, 2017. "Price-Linked Subsidies and Imperfect Competition in Health Insurance," NBER Working Papers 23104, National Bureau of Economic Research, Inc.
    2. Florian Heiss & Daniel McFadden & Joachim Winter & Amelie Wuppermann & Bo Zhou, 2016. "Inattention and Switching Costs as Sources of Inertia in Medicare Part D," NBER Working Papers 22765, National Bureau of Economic Research, Inc.
    3. repec:sip:dpaper:15-012 is not listed on IDEAS
    4. Kate Ho & Joseph Hogan & Fiona Scott Morton, 2015. "The Impact of Consumer Inattention on Insurer Pricing in the Medicare Part D Program," NBER Working Papers 21028, National Bureau of Economic Research, Inc.
    5. Camilo Cid & Randall P. Ellis & Verónica Vargas & Juergen Wasem & Lorena Prieto, 2015. "Global Risk-Adjusted Payment Models," Boston University - Department of Economics - Working Papers Series wp2015-021, Boston University - Department of Economics.
    6. Michael Grubb, 2015. "Failing to Choose the Best Price: Theory, Evidence, and Policy," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 47(3), pages 303-340, November.
    7. Daniel McFadden & Carlos Noton & Pau Olivella, 2015. "Minimum coverage regulation in insurance markets," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 6(3), pages 247-278, August.
    8. Francesco Decarolis & Maria Polyakova & Stephen P. Ryan, 2015. "The Welfare Effects of Supply-Side Regulations in Medicare Part D," NBER Working Papers 21298, National Bureau of Economic Research, Inc.
    9. Maria Polyakova, 2016. "Regulation of Insurance with Adverse Selection and Switching Costs: Evidence from Medicare Part D," American Economic Journal: Applied Economics, American Economic Association, vol. 8(3), pages 165-195, July.
    10. Liran Einav & Amy Finkelstein & Maria Polyakova, 2016. "Private Provision of Social Insurance: Drug-specific Price Elasticities and Cost Sharing in Medicare Part D," NBER Working Papers 22277, National Bureau of Economic Research, Inc.
    11. Jaffe, Sonia & Shepard, Mark, 2017. "Price-Linked Subsidies and Health Insurance Markups," Working Paper Series rwp17-002, Harvard University, John F. Kennedy School of Government.
    12. Decarolis, Francesco, 2015. "The unintended effects of the Medicare Part D low income subsidy," Health Policy, Elsevier, vol. 119(5), pages 597-603.
    13. repec:eee:hapoch:v1_237 is not listed on IDEAS
    14. Nicola Branzoli, 2016. "Price dispersion and consumer inattention: evidence from the market of bank accounts," Temi di discussione (Economic working papers) 1082, Bank of Italy, Economic Research and International Relations Area.
    15. Paul J. Eliason & Paul L. E. Grieco & Ryan C. McDevitt & James W. Roberts, 2016. "Strategic Patient Discharge: The Case of Long-Term Care Hospitals," NBER Working Papers 22598, National Bureau of Economic Research, Inc.
    16. Fang, H., 2016. "Insurance Markets for the Elderly," Handbook of the Economics of Population Aging, Elsevier.
    17. Francesco Decarolis & Andrea Guglielmo, 2016. "Insurers' Response to Selection Risk: Evidence from Medicare Enrollment Reforms," NBER Working Papers 22876, National Bureau of Economic Research, Inc.
    18. Colleen Carey, 2017. "Technological Change and Risk Adjustment: Benefit Design Incentives in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 9(1), pages 38-73, February.
    19. Andrew Stocking & James Baumgardner & Melinda Buntin & Anna Cook, 2014. "Assessing the Design of the Low-Income Subsidy Program in Medicare Part D: Working Paper 2014-07," Working Papers 49451, Congressional Budget Office.

    More about this item

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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