Medicare, MA: Medicare Beneficiaries Like Their Coverage, Prior Authorization, MCIT Delay

Medicare’s older adults still like their coverage and report fewer cost-related problems than privately insured adults ages 50 to 64, despite receiving similar care to that age bracket.

The study from Kaiser Family Foundation said that rapidly growing healthcare spending is of concern for consumers and the relatively high prices from insurers are the reason for that trend. There’s currently proposed legislation to lower costs for consumers by lowering the Medicare qualifying age from 65 to 60. The study looked at data from the 2018 Medicare Current Beneficiary Survey and the 2019 National Health Interview Survey.

A new bill introduced in the U.S. House of Representatives this week would create an electronic prior authorization process for Medicare Advantage plans in order to streamline what has thus far been an administrative burden for medical providers. It would also create a process for payers to clear items and services that are routinely approved and improve transparency.

From co-sponsor Representative Suzan Delbene (D-WA), via Fierce Healthcare:

The majority of the healthcare community agrees that prior authorization needs to be reformed.

The Centers for Medicare and Medicaid Services (CMS) has delayed implementation of a payment rule that would give breakthrough devices Medicare reimbursement automatically when they are cleared by the Food and Drug Administration (FDA) until December 15 of this year. According to MedTechDive, the Medicare Coverage of Innovative Technology (MCIT) initiative was strongly supported by medtech developers and manufacturers but CMS says that it is concerned that MCIT would make it difficult to ensure that the devices have value for beneficiaries.

Clover Health, a Medicare Advantage insurer that merged with a high-value special purpose acquisition company before entering the market for public trading in January, announced that it would meet less than half of its expected enrollment goal of 200,000 beneficiaries. Clover executives also cite COVID-19 as the source of higher-than-expected costs for the plan, Forbes reports. The insurer posted a net loss of $48.4 million on $200.3 million in revenue in the first quarter, despite the 21% revenue increase year-over-year.

The increasing number of audits and investigations into providers and businesses that receive Medicare and Medicaid funding is putting a strain on overall costs for each program, according to Francis Serbaroli in the New York Law Journal. This cost increase comes from both state and federal governments allocating resources to combatting fraud in the Medicare and Medicaid programs, private insurers increasing their review of bills submitted for medical care and providers protecting themselves from audits and investigations.