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- Janet on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Kristina on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Curt Black on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Margaret on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Jane Wall Medicare Health Benefits Inc on Strange Bedfellows Come to Medicare Advantage’s Rescue
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Topic: Policy & Health Reform
The Future of Medicare Advantage
The Alliance for Health Reform and the Kaiser Family Foundation (KFF) sponsored a meeting on the Future of Medicare Advantage (MA) on the day that KFF reported that MA enrollment had reached a historic 28 percent of the Medicare population. A major theme of the conference was whether MA enrollment could be sustained or increased in the face of substantial ACA budget cuts in the next few years. The discussion took place against the backdrop of substantially revised Congressional Budget Office (CBO) projections in their May 2013 Medicare baseline that modified a prediction that MA enrollment would decline to 11 million by 2017 to a new assumption that MA enrollment would increase to 21 million by 2023. CBO did not explain their shifting opinion and the panelists had no inside information on the CBO assumptions.
Drugs and Patient Safety – the Disconnect
The recent Washington Post piece published May 11, 2013, on the prescription drug dangers for Medicare patients raises some interesting points about the current prescribing habits of some outlier physicians/prescribers, as well as the lack of a coordinated effort to exclude those same prescribers from participating in Medicare.
Proposed Benefits Manual Changes
On April 25, 2013 CMS issued a proposed update to the Benefits and Beneficiary Protections Chapter (Chapter 4) of the Medicare Managed Care Manual. The CMS cover letter provides a good summary of the changes that they are proposing to make. Most of the changes are clarifications to existing policy, for example, providing Medicare Advantage plans (MA) with the option of charging beneficiaries higher cost sharing for non-emergency out-of-network services and prohibiting MA plans from imposing policies that prevent enrollees from accessing a Part B drug administered in a physician’s office. CMS is removing the example of how total beneficiary cost-sharing (TBC) is calculated and instead stating that TBC requirements will be included in the Call Letter, as they did for 2014.
Medicare Essential – Is this the future of Medicare?
According to The Hill’s Elise Viebeck President Obama is receptive to combining Medicare Part A (in-patient hospital) and Part B (outpatient and doctor) deductibles, into a single deductible just like every other insurance scheme in the US. Predictably those to his left complained, maybe because Virginia’s Eric Cantor also likes the idea. The impact would raise the deductible for people who use only physician services, lower it for anyone who is hospitalized, and, net, save Medicare money by shifting more costs to beneficiaries. However, some of the savings would also be used to add an annual out-of-pocket cap on what beneficiaries would have to spend. This is good insurance logic: don’t cover relatively low cost, predictable expenses. Focus coverage on protecting beneficiaries from catastrophic loss.
Medicare Shared Savings Program Circa 2014
Anyone who has paid attention knows that since 2011 more than 200 Medicare ACO’s have been operationalized. If you add in commercial ACO’s, the number is closer to 400.
QHP Submission Reprieve
OK, so maybe reprieve is not the right word, since according to Google it is defined as “a cancellation or postponement of a punishment”. If you consider a deadline a punishment, then I suppose this is a reprieve, but I digress.
So You Want to File a QHP Application
This will be the title of my instructional pamphlet that I envision sitting in a doctor’s office, among other great pamphlets such as “Talking to Your Kids about Drugs” and “Depression: Not Just a Hole in the Ground”.
