While the Centers for Medicare and Medicaid Services (CMS) are moving forward with tighter regulations on the Medicare Advantage (MA) program, the Heritage Foundation argues that freeing MA from the constraints of Medicare Fee-For-Service (FFS) payment rates and making it the default Medicare enrollment system would offer a solution to...
Medicare-eligible seniors face more options than ever when considering Medicare Advantage (MA) and supplemental coverage. This year, the average beneficiary has nearly 70 different MA and Medicare Part D stand-alone plan options, with a litany of supplemental benefit offerings including many related directly to primary care.
According...
The Centers for Medicare and Medicaid Services (CMS) have heard beneficiary complaints about predatory marketing tactics by Medicare Advantage (MA) companies and is taking action.
In August, Senator Ron Wyden (D-Ore.), Chair of the Senate Finance Committee, began an investigation into deceptive marketing practices . Last week, the...
Every year, ahead of the Medicare Advantage open enrollment period, the Centers for Medicare and Medicaid Services (CMS) publish Medicare Part C and Part D Star Ratings to give Medicare beneficiaries a metric by which to assess plans. Last week, CMS released the 2023 Star Ratings for qualifying MA plans.
Medicare Advantage plans are...
The Medicare Advantage lobby is leaping into action to defend MA plans from the wave of scrutiny and proposed regulation with two separate studies published last week that demonstrate the benefits to MA enrollee pocketbooks and federal spending over traditional Medicare.
The first study, which was sponsored by the nation's largest...Arizona News
This week in Medicare Advantage news, prior authorization reform garners the support of the Better Medicare Alliance, Puerto Rico offers insight into the future of the MA program, a CMS rule on third-party marketing goes into effect and we share some acquisition news.
Last week, the Better Medicare Alliance, the largest lobby for...National News
Talks between Sen. Joe Manchin (D-W.Va.) and Senate Majority Leader Charles E. Schumer (D-N.Y.) laid the groundwork for a new drug pricing proposal that may be advanced during a budget reconciliation process; the proposal also includes a cap on annual out-of-pocket prescription drug costs for beneficiaries, limits the amount drug...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
This week in Medicare Advantage (MA), the program is on track to account for 54% of Medicare spending by 2030 and the Centers for Medicare and Medicaid Services (CMS) finalized the plan rates for 2023. Also, Humana takes a look at social needs in Medicare Advantage before COVID and eHealth looks at the rise in premiums and deductibles...
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the final 2023 Medicare Advantage (MA) Part D rate announcement, which includes an 8.5% rate increase for MA and Part D plans. The agency will not adjust the MA star rating system but will be soliciting solutions to the system that incorporates a path to the Biden...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
The Medicare Payment Advisory Commission (MedPAC), the panel that advises Congress on Medicare policy, released new findings last Friday that demonstrate a surge in popularity for the Medicare Advantage program but raises alarms about upcoding practices that have spiked Medicare spending.
Over 50% of Medicare beneficiaries are...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that takes aim at prescription drug costs in Medicare Advantage (MA) and Medicare Part D plans. The agency said the rule would reduce out-of-pocket costs for beneficiaries and improve price transparency as well as "market competition in the Part D...National News
Following months of tense negotiations between moderate Congressional Democrats and the White House, Senator Joe Manchin (D-WV) ended any hopes for passing President Joe Biden's Build Back Better Bill on Sunday. This leaves many of the sorely needed healthcare spending and reform initiatives in limbo, although some Democrats hope to pass...National News
After months of negotiations, the Build Back Better Act is taking form as a bill that appeases the concerns of most Congressional Democrats, including holdouts like Senators Kyrsten Sinema (D-AZ) and Joe Manchin (D-WV). The bill will now include a number of healthcare-related solutions and improvements to public health insurance programs...News
A new KFF analysis found that Black Medicare beneficiaries are more likely to have cost-related problems with their healthcare than White beneficiaries; the racial disparity persisted among beneficiaries in both traditional Medicare and Medicare Advantage plans.
About 28% of Black beneficiaries reported healthcare cost-related...National News
A new bill in the senate, proposed by Senator Debbie Stabenow (D-MI) and other Senate Democrats would allow people under 65 and over 50 to buy into Medicare. WEAU 13 reports that 27% of adults approaching retirement age are not confident that they can afford health insurance, and more than 25% have difficulties navigating insurance...CMS Rules
Last Friday, the Trump administration announced two interim final rules in a last-ditch effort to fulfill the president’s campaign promises of lowering drug prices for seniors. Many of President Trump’s prior efforts were blocked by litigation or lost momentum during the rule making process. With eight weeks left in his presidency,...CMS Rules
For the first time in the last decade, the Centers for Medicare and Medicaid Services (CMS) updated the popular health plan shopping tool Medicare Plan Finder, but the recent redesign initiative has raised concerns for consumer advocacy groups that say the tool offers inaccurate information.
The federal government spent $11 million...Arizona News
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to lower prescription drug costs for beneficiaries by making changes to Medicare Part D. The proposal could give insurers negotiating powers on drug prices by offering an expectation that plans would implement broader use of prior authorization (PA)...
