Tag Archives: Health Reform

Federally Facilitated Exchanges: The draft application for qualified health plans

Steve Balcerzak

In at least 23 states, governors are allowing a “Federal takeover” in the form of a federally facilitated exchange (FFE).  Now, CMS has published the first draft of the application that health plans need to complete to become a qualified health plan (QHP) in the CMS FFE.  To be sure, the exchange regulation allows individual exchanges flexibility in defining rules and operations, provided they meet the basic requirements.  This flexibility applies equally to how CMS interprets its role in operating exchanges in the FFE states.

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Of course they should! (But not for the reason you may think)

Gorman Health Group

The New York Times reports that Hospitals fear they may bear the brunt of Medicare cuts.  I should hope so!  But not because they are wildly profitable at the expense of efficiency and innovation elsewhere.

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Election Gives Health Reform the Kiss of Life

John Gorman

It’s hard to argue this wasn’t a decisive victory for the President and Democrats in the Senate.  What remains to be seen is whether intractable Congressional Republicans will come to the table to get stuff done.

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The Impact of the Election On Medicare Private Plans

Jean LeMasurier

Now that President Obama has been re-elected, the Affordable Care Act (ACA) will not be repealed and the ACA provisions impacting Medicare Advantage (MA) plans and Prescription Drug Plans (PDPs) will continue to be implemented.

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Public and Private Exchanges

Jean LeMasurier

It appears that Medicare beneficiaries who use the most health care services and are often considered the least able to shop over the internet for health insurance may have been the trailblazers for how health insurance will be purchased in the future. Medicare took a first step in the 1990s when it created a voluntary online marketplace where Medicare beneficiaries could select a Medicare Advantage private plan from the government run internet site “Medicare Compare”. Medicare expanded the experiment when it implemented the Part D prescription drug plan benefit in 2006. At that time, all seniors and disabled beneficiaries who were not covered by an employer drug plan were required to shop and select from an online menu of new prescription drug plans during a short open enrollment period.

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Open Enrollment and Star Ratings for 2013

Jean LeMasurier

Open enrollment season has started and CMS has posted the star ratings for each Medicare Advantage (MA) plan and Prescription Drug Plan (PDP) on the Medicare.gov website, which is the official site beneficiaries use to get information on their plan choices. Five star plans get a special gold star icon and have special enrollment periods. Higher performing MA plans also receive higher bonuses. Low performing plans are also designated by a special icon on the Medicare website. Most MA plans whose rating fell will see a decrease in their payments in 2014.

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With Presidential Election Static, Senate Slips from GOP’s Grip

John Gorman

The most frequent question I get is “what will the elections mean to Medicare and Medicaid?” We’ve said here the Republicans’ only hope of repealing the Affordable Care Act and enacting entitlement reform comes from making President Obama a one-termer, maintaining their majority in the House, and retaking the Senate.  At the moment the Presidential race remains largely unchanged, with Mitt Romney getting a disappointing bounce from the GOP convention; Republicans will likely hold the House, but their grip on retaking the US Senate is slipping — and with it, any chance of ObamaCare repeal or major changes to Medicare and Medicaid.

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