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consumer.141 A MAP could offer LTSS benefits beyond those contained in Original Medicare, but such coverage expansion is not common. Continued consolidation of health insurers is likely to affect the Medicare Advantage Program by reducing the number of competing MAPs available to any particular Medicare-eligible consumer considering this option. Some parts of the U.S. already experience an absence or dearth of MAPs available for selection by local Medicare enrollees,142 and consolidation can only make that circumstance worse. MAP enrollment is already concentrated among a handful of large insurers. For instance, Humana and UnitedHealth together provide coverage for nearly 40 percent of all people enrolled in MAPs.143 Some parts of the country that now have one or a few MAPs available may, following mergers and consolidations, have even fewer or no competing MAPs. Those Plans that continue to offer products for Medicare enrollees in a particular area may be able to provide more restrictive provider networks144 while raising the size of the consumer’s financial contribution to care as a business practice due to lessened competition for consumers (through imposition of increased premium amount, deductible, co-pay, and co- insurance requirements).145 Because MAPs today rarely offer LTSS coverage beyond that required to match Original Medicare, the hypothesized effects of consolidation on Medicare Advantage should be minimally felt in the LTSS arena. Nevertheless, investigation of consolidation’s impact on the availability, affordability, and content of MAP generally, and on LTSS for Medicare beneficiaries specifically, should be placed solidly on the health services research agenda.
141. See Rachel O. Reid et al., The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: An Observational Study, 31 J. GEN. INTERNAL MED. 234, 237-38 (2016); see also Paul D. Jacobs & Melinda B. Buntin, Determinants of Medicare Plan Choices: Are Beneficiaries More Influenced by Premiums or Benefits?, 21 AM. J. MANAGED CARE 498, 503 (2015). 142. See Brian Biles et al., Competition Among Medicare’s Private Health Plans: Does It Really Exist?, COMMONWEALTH FUND 1 (Aug. 2015), http://www.commonwealthfund.org/~ /media/files/publications/issue- brief/2015/aug/1832_biles_competition_medicare_private_plans_ib_v2.pdf. 143. See Drew Altman, Amid Merger Talk, A Look at Health Insurers’ Medicare Business, WALL ST. J. (July 1, 2015, 9: 49 AM), http://blogs.wsj.com/washwire/2015/ 07/01/amid-merger-talk-a-look-at-health-insurers-medicare-business. 144. See Can I Get My Health Care from Any Doctor, Other Health Care Provider, or Hospital in Medicare Advantage Plans?, MEDICARE.GOV, https://www.medicare.gov/sign-up- change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans- network-comparison.html#collapse-3306 (last visited Apr. 15, 2016). 145. See Laura M. Keohane et al., Medicare Advantage Members’ Expected Out-of- Pocket Spending for Inpatient and Skilled Nursing Facility Services, 34 HEALTH AFF. 1019, 1025 (2015).