Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...
As public and political pressure has risen against prior authorization, insurers are scaling back use of the policy and are openly reforming the process.
Back in February, the American Medical Association (AMA) led 118 other medical organizations to write a letter to the Centers for Medicare and Medicaid Services, specifically...
Rural hospitals experience unique issues as providers across the medical industry, and specifically in regards to Medicare Advantage (MA). Plan availability, the structure of available plans, and difficulties with processing payments are all reasons rural health systems are increasingly fighting MA.
A new study by Milliman highlights...
Most MA growth was driven by switchers and younger and healthier Medicare beneficiaries had better odds of switching from Original Medicare to Medicare Advantage (MA), but lower odds of switching from MA to Original Medicare. Complicating matters: older and sicker beneficiaries were more likely to switch out of MA into Original Medicare....National News
Humana has filed suit against the Centers for Medicare and Medicaid Services (CMS) for a rule announced earlier this year that would allow the government to recoup overpayments from insurers based on extrapolated audits. Also, Novartis has challenged the Biden administration over the Medicare Drug Price Negotiation rule.
Studies have...
Amidst a growing call to reform Medicare Advantage monetary incentives like the Quality Bonus Program (QBP), insurers are announcing that they will receive record high bonus payments from the Medicare program.
Federal spending on bonus payments is expected to reach $12.8 billion this year, with UnitedHealthcare expected to take home...
The Medicare system is on a crash course toward insolvency, and the evidence is mounting that overpayments to Medicare Advantage plans and the use of pharmacy benefit managers (PBMs) are responsible for a great deal of those overpayments.
Two researchers, Steven Lieberman and Paul Ginsberg, Ph.D, published a study earlier this year...Open
Amid a national mental health crisis affecting the very old and very young alike, a new study shows that enrolled in Medicare Advantage are far less likely to have access to psychiatric care than beneficiaries of other government-coordinated plans.
The study, which was published in Health Affairs, looked at a novel data set that...
A white paper by the Harvard Medical School in partnership with software company Inovalon found that Medicare Advantage enrollees are more likely to be poor than enrollees in Traditional Medicare.
The average income of a Medicare fee-for-service (FFS) beneficiary is $85,085 but the median Medicare Advantage enrollee earns $76,720....
Two studies published this week highlight the differences between Medicare Advantage and traditional Medicare in terms of enrollment growth and use of certain medications.
The first study, published in JAMA Health Forum, found that MA plan payment cuts under the Affordable Care Act (ACA) did not lead to any enrollment reductions....
The Medicare Payment Advisory Commission (MedPAC) published its annual June Report to Congress, which includes suggestions to unify payment methodologies for post-acute care, address issues within Medicare Advantage, and lower telehealth payments.
The MedPAC recommendations for streamlining payment methodologies for skilled nursing...
A new study by University of Southern California (USC) Leonard D. Schaeffer Center for Health Policy and Economics estimates that overpayments to Medicare Advantage plans could exceed $75 billion annually or 20% of total payments.
The report doubles overpayment estimates made by the Medicare Payment Advisory Commission (MedPAC), which...
Last week, the U.S. Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy released an overview of the state of Medicare Advantage enrollment and program spending. This is the first such report since the Medicare to Medicare Advantage enrollment ratio hit 50-50.
The...White Papers, E books, Reports and more
A new study shows that dually eligible Medicare Advantage enrollees received poorer clinical care than those who were not dually enrolled.
The Centers for Medicare and Medicaid Services (CMS) Office of Minority Health (OMH) released a report this week based on analysis of Healthcare Effectiveness Data and Information Set (HEDIS),...White Papers, E books, Reports and more
The Medical Group Management Association (MGMA) published a report last week on the issues brought about by Medicare Advantage (MA) plans' use of prior authorization.
MGMA surveyed 600 medical groups on the use of PA and found that it contributes to increased costs and delays or denials of care. Groups overwhelmingly reported that...
Humana has revised its outlook, confident that its expected Medicare Advantage enrollment will increase even more than it originally anticipated in 2023. But Centene has reported the opposite, expecting to lose money in Medicare Advantage and from Medicaid redeterminations.
Centene released its first quarter (Q1) corporate reports on...
Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms.
The rule stipulates that once a health plan grants prior authorization for a service, the approval will...
Lawmakers and stakeholders are still very upset with the U.S. Department of Health and Human Services' (HHS) plan to cut payments to the Medicare Advantage (MA) program and to enforce regulations against MA plans that have benefitted financially from improper overpayments. This week, HHS Secretary Xavier Becerra defended the rule in two...
This week, some of the insuretech companies that spent the past year struggling are trying to change their fortunes. Oscar Health brings on a seasoned, experienced CEO with a new goal and Bright Health is making some desperate stock moves.
Mark Bertolini, former CEO of Aetna and hedge fund Bridgewater Associates was appointed CEO of...