This evaluation examined success of a demonstration program in which enrollment in the Department of Defense’s (DoD’s) Senior Prime plan was offered to military retirees over age 65 who: lived within 40 miles of the primary care facilities of one of the six sites, had recently used military health facility services, and were enrolled in Medicare Part B. Medicare made a capitation payment to DoD for each enrollee, where DoD maintained a level of effort for health care services to all retirees who were also Medicare beneficiaries, whether or not they chose to enroll. The evaluation examined issues in four basic areas: (1) enrollment demand, (2) enrollee benefits, (3) cost, and (4) impact on other DoD and Medicare beneficiaries. The study found that the plans experienced significant challenges in the submission of their data to fiscal intermediaries and carriers using established Medicare fee-for-service billing regulations. Programs were provided extensive technical assistance including in-person visits to address these issues.
PIC ID: 7171
Agency Sponsor: CMS, Office of Research, Development & Information
Federal Contact: McVicker, Victor, 410-786-6681
Performer: Rand Corporation, Santa Monica, CA