Headlines about "Medicare and Medicaid"
Gathered from the web by the editors at BenefitsLink.com.
[Guidance Overview] Medicare Law Will Impact Private Fee-for-Service Plans (PDF)
Excerpt: "On July 15, Congress overrode President Bush's veto of Medicare legislation that blocked cuts in physician payments and provided enhanced benefits to Medicare beneficiaries. Most significant for employers are provisions that reduce funding for Medicare Advantage plans and that change how private fee-for-service plans must be structured." (Buck Consultants)
[Guidance Overview] Medicare Part D Creditable Coverage Notices Are Updated
Excerpt: "[The Centers for Medicare & Medicaid Services' three Model Notices are revised primarily to reflect formatting and organization changes. Substantive changes appear minor but include: Re-Enrollment: Definitive disclosure of whether the individual can re-enroll in the plan after dropping coverage. Medicare Special Enrollment Period: Clarification that the special enrollment period for enrollment in Medicare Part D is 2 months (rather than 60 days) after loss of Creditable Coverage." (Deloitte via BenefitsLink.com)
Medicare Reform Law May Impact Retiree Medical Plans (PDF)
1 page. Excerpt: "The recently passed Medicare Patients and Providers Act of 2008 (the 'Act') includes a number of reforms to Medicare which may impact employer sponsored retiree medical plans. Specifically, the Act imposes additional requirements on Medicare Private Fee for Service ('PFFS') plans." (Haynes and Boone, LLP)
[Opinion] Make Original Medicare the Foundation for Health Care Reform
Excerpt: "[O]riginal Medicare stands as a shining example of a needs-based program that has consistently served the public interest. Despite being weakened by privatizing, it gives us a solid foundation for real health care reform, when access to necessary health care is even more difficult than in the 1960s. It is time to expand Medicare as a social insurance program for all Americans through a single risk pool of all 300 million of us. This is the most efficient, fair and sustainable way to insure us all against the costs of illness and injury, coupled with the strengths of our private delivery system." (Seattle Post Intelligencer via California Nurses Association / National Nurses Organizing Committee)
Legislation Would Require Greater Transparency in Physician Self-Referrals for Imaging Procedures
Excerpt: "Senate Finance Committee ranking member Chuck Grassley (R-Iowa) recently introduced legislation (S 3343) that would require physicians to disclose their financial ties to imaging services ordered under Medicare when making self-referrals, CQ HealthBeat reports." (Kaiser Family Foundation)
2009 Retiree Drug Subsidy Application Deadline Is Near
Excerpt: "Retiree medical plan sponsors that want to receive the Medicare Part D retiree drug subsidy (RDS) for the 2009 calendar year should begin the application process now. Calendar-year plans must apply for the 2009 RDS by Oct. 2, 2008 -- 90 days before the start of the plan year for which the subsidy is sought. The RDS requires a new application for each plan year, even if a sponsor previously received the subsidy. Applications that fail to include a new actuarial attestation, signed plan sponsor agreement and list of qualifying covered retirees will be denied." (Mercer LLC)
[Guidance Overview] CMS Posts Spanish-Language Versions of Model Disclosure Notices for Medicare Part D Eligible Individuals
Excerpt: "CMS officials have informally indicated that the Medicare Part D rules do not require group health plan sponsors to provide the disclosure notices in languages other than English. Nevertheless, sponsors of plans with participants who speak Spanish may find the Spanish-language versions of the notices to be useful in educating portions of their workforce about Medicare Part D." (Employee Benefits Institute of America)
[Guidance Overview] COBRA Was Required for Former Employee Receiving Social Security Disability Benefits
Excerpt: "Medicare entitlement can affect an individual's COBRA rights in several different ways, and keeping all the rules straight is not an easy task. This case illustrates that one source of confusion can be the various benefit programs that the SSA operates. As this court explains, receipt of Social Security disability benefits does not justify a failure to provide COBRA." (Employee Benefits Institute of America)
[Guidance Overview] Medicare Reform Bill Passes Over President Bush's Veto
Excerpt: "The Medicare reform law will creates issues for plan sponsors that provide retiree health coverage. If a plan sponsor currently offers Medicare Advantage Private-Fee-for-Service (PFFS) plans, it may want to look into a switch or migration in the next couple of years into other Medicare Advantage (MA) plan types or consider offering coverage that supplements traditional Medicare." (The Segal Group, Inc.)
Medicare Part D a Boon for Drug Companies, House Report Says
Excerpt: "U.S. drug manufacturers are reaping a windfall from taxpayers because Medicare's privately administered prescription drug benefit program pays more than other government programs for the same medicines, a House committee charged in a report Thursday." (Los Angeles Times)
General Motors Working with Firm to Help Retirees Transition to Medicare Coverage
Excerpt: "General Motors will contract with benefits consultant firm Extend Health to provide guidance to retirees in choosing appropriate Medicare plans to replace benefits previously offered by GM, the Detroit Free Press reports." (Kaiser Family Foundation)
[Guidance Overview] Updated Medicare Part D Notices (PDF)
1 page. Excerpt: "The Center for Medicare and Medicaid Services ('CMS') recently updated the model notices required under Medicare Part D, including the model notices of creditable and non-creditable coverage. For any notice of creditable or non-creditable coverage provided after June 15, 2008, plan sponsors should utilize these updated notices." (Haynes and Boone, LLP)
Sen. Kennedy Wins Fight Against Creeping Privatization of Medicare
Excerpt: "[Ted Kennedy, who is fighting a brain tumor, made a dramatic appearance on the Senate floor, casting the decisive vote on the Medicare payment bill] amid cheers from his colleagues. . . . But the vote was bigger than the theatrics. It was the first major health care victory that Democrats have won in a long time. And it was enormously encouraging for advocates of universal health care." (The New York Times; free registration required)
American Academy of Actuaries Posts an 'Election 2008' Section
Excerpt: "A special election-year series from the Academy, offering short summaries of key issues from an actuarial perspective. [Key issues: Health care reform and Medicare reform; Social Security reform.]" (American Academy of Actuaries)
McCain Says He Would Balance Budget by 2013
Excerpt: "In the economic white paper his campaign released yesterday, he acknowledges that 'the only way to keep the budget balanced is successful reform of the large spending pressures in Social Security, Medicare, and Medicaid.' But he did not offer details about how he would achieve those reforms." (The Washington Post; free registration required)
[Guidance Overview] CMS Issues Updated Disclosure Notices to Medicare Part D Eligible Individuals for Use After June 15, 2008
Excerpt: "The changes should make the model notices more accessible and easier for individuals to understand. Employers using the model disclosure notices will need to replace them with the updated versions. Those using customized versions of the notices should look at the updated model notices to see if any of the changes should be incorporated." (Employee Benefits Institute of America)
[Opinion] 5 Myths About the Bust That Will Follow the Boom(ers)
Excerpt: "The warnings have rumbled for decades: Just wait till the baby boomers retire. If you think there are strains on Social Security and Medicare now, brace yourselves for the implosion as the boomers start heading out to pasture. With the first of that generation now doing just that, we should be seeing the dust cloud soon, right? Actually, if you've bought into the . . . myths about the bust the baby boom is supposed to usher in, you may be surprised." (The Washington Post; free registration required)
Segal Medicare Part D Survey of Multiemployer Health Funds (PDF)
2 pages. Excerpt: "The survey found that most multiemployer health funds continue to take the Retiree Drug Subsidy (RDS). We expect that will change in the coming years as RDS administration becomes increasingly challenging for plan sponsors." (The Segal Group, Inc.)
More Than 500 Backlogged Whistle-Blower Cases Allege Health Care, Drug Company Fraud
Excerpt: "Whistle-blower lawsuits alleging that pharmaceutical companies and government contractors defrauded the federal government have created a backlog of more than 900 cases at the Department of Justice, the Washington Post reports. According to the Post, more than 500 of the cases involve the health care and pharmaceutical industries, as well as Medicare and Medicaid." (Kaiser Family Foundation)
[Opinion] The Battle to Save Medicare
Excerpt: "Reader Jack Wajda, 69, of Orlando, a retired AT&T executive and financial planner, identifies the single greatest problem with the American health-care system as well as anyone. He writes: 'To allow private for-profit insurance companies to decide whether and what type of care we receive is incomprehensible to me.'" (Saul Friedman via Newsday)
[Opinion] Employers' Coalition on Medicare Writes to Express Concerns with Medicare Legislation Currently Under Development (PDF)
1 page. Excerpt: "Limitations on employers' ability to offer the [Medicare Advantage Private Fee-for-Service] option, as well as severe reductions in MA payments, would hurt retirees who prefer these plans, and would disproportionately hurt beneficiaries who are located in areas where there are no other Medicare Advantage options available." (American Benefits Council)
[Opinion] A Retirement Income Solution - Create a Senior Class of Worker
Excerpt: "To get back to the real world, employers will need incentives to hire older workers. So here's my plan, inspired in part by this article in last Sunday's New York Times: create a 'senior class' of employee for those 62 and up. Employers would no longer have to contribute their share of Social Security taxes for such employees 62 and over -- although employees would continue contributing their share and continue to earn credit for paying into the system." (Investment News; free registration required)
[Opinion] High Medicare Costs, Courtesy of Congress
Excerpt: "For years, Congress has set the price for walkers and various medical equipment, and it has consistently set them well above the market rate, effectively handing out a few hundred million dollars of corporate welfare every year to the equipment makers. But as of July 1, this system is set to change. Companies will instead have to submit bids -- to compete with one another, just as Wal-Mart competes with Target -- if they want to continue selling products to Medicare." (The New York Times; free registration required)
Public and Private Health Insurance: Comparing the Costs
Excerpt: "Analyses of data from the 2005 Medical Expenditure Panel Survey indicate that total medical spending is much lower when coverage is provided by Medicaid or SCHIP than it is when coverage is provided by private insurance. Public insurance is particularly advantageous from the consumer's perspective because associated out-of-pocket spending is far lower." (Health Affairs)
[Guidance Overview] Centers for Medicare & Medicaid Services Issues Additional Guidance on Rebate Adjustments for the Retiree Drug Subsidy Program (PDF)
2 pages. Excerpt: "Recent CMS guidance clarifies that the requirement that plan sponsors report rebates retained by a Pharmacy Benefit Manager applies only to RDS applications with plan years starting on or after January 1, 2007." (Buck Consultants)
What the 2008 Trustees' Reports Tell Us About the Financial Status of Social Security and Medicare: Some Implications for Plan Sponsors
Excerpt: "This article reviews briefly the results of this year's reports and comments on their implications for employer sponsors of retirement and health plans." (Watson Wyatt Worldwide)
Cost Trends for Chronic-Condition Cohorts with Medicare Benefits (PDF)
36 pages. (Milliman)
The Nation's Long-Term Fiscal Outlook Is Unsustainable, Government Report Says; Health Care Cost Growth and Demographic Trends Are Biggest Problems (PDF)
14 pages. Excerpt: "Our updated simulations continue to illustrate that the long-term fiscal outlook is unsustainable. Despite some improvement in the long-term outlook for federal health and retirement spending, the federal government still faces large and growing structural deficits driven primarily by rising health care costs and known demographic trends. In fact, the oldest members of the baby boom generation are now eligible for Social Security retirement benefits and will be eligible for Medicare benefits in less than 3 years." (Government Accountability Office)
Federal Government's Long-Term Liabilities Total $57.3 Trillion
Excerpt: "The federal government's financial obligation to cover the lifetime benefits of people eligible for government programs increased by $2.5 trillion last year to $57.3 trillion, largely due to rising Medicare obligations" (KaiserNetwork.org)
[Guidance Overview] CMS Final Medicare Part D Regulations Affect Retiree Drug Subsidy (PDF)
3 pages. Excerpt: "CMS recently issued final regulations that make policy clarifications and technical corrections to its earlier final regulations on Medicare Part D. The regulations contain provisions affecting the retiree drug subsidy program, including clarification of rules regarding the timing of applications for the subsidy, submission of actuarial attestations upon a material change and changes to the rules for determining actuarial equivalence." (Buck Consultants)
Long-Term Care Insurance: Partnership Plans and the Impact of Other Legislation
Excerpt: "Why is true group long-term care so important? Many Americans will have no way to pay for long-term care services when they are needed. Insurance for long-term care will not become widespread if only available on an individual basis, which means that the change will need to come first from employers. Group coverage needs to include employer contributions to make it affordable to employees and vesting to make it affordable to employers." (Milliman)
[Opinion] The Age of Tinkering with the Framework of Entitlements Has Begun
Excerpt: "The age of guaranteed benefits is hardly over, but anxiety over the fraying of the safety net -- private as well as public -- is palpable. It is true that not one of the three White House contenders has offered a comprehensive solution. And except for Barack Obama's proposal that the wealthy pay more in payroll taxes, none have been so bold as to suggest that the government meet its entitlement obligations by raising its take on them. But each has suggested some intriguing fixes that, while differing in the details, all seek to alleviate the entitlement problem by stimulating individual savings." (The New York Times; free registration required)
States Look to Rein In Private Medicare Plans
Excerpt: "In the draft of a report prepared by the National Association of Insurance Commissioners, state officials say they have received large numbers of complaints but, in most cases, cannot provide direct assistance to beneficiaries or hold insurers accountable. In the report, the state officials propose setting common standards for marketing the private plans, which could then be enforced by states that adopt them. 'The current federal regulatory framework does not adequately protect consumers from marketing and sales abuses,' and consumers are often left to fend for themselves in 'a bifurcated regulatory system,' the draft report says." (The New York Times; free registration required)
[Guidance Overview] CMS Issues Medicare Part D Benefit Parameters for 2009
Excerpt: "EBIA Comment: The new parameters will help group health plan sponsors determine whether their plans' prescription drug coverage is creditable for 2009. This information is needed for the disclosures that must be made annually and at other specified times to Part D eligible individuals and to CMS." (Employee Benefits Institute of America)
[Guidance Overview] Side-by-Side Comparisons of Current and 'HIPAA 2' EDI Standards Posted on CMS Website
Excerpt: "EBIA Comment: Health plans are required to comply with the EDI standards that apply to all covered entities, as well as some additional requirements specific to health plans. Covered entities (including health plans) and their business associates may find the side-by-side comparisons helpful in assessing the potential impact of the HIPAA 2 changes." (Employee Benefits Institute of America)
[Opinion] Social Security and Medicare Projections: 2008
Excerpt: "The 2008 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs has reached $101.7 trillion in today's dollars! That is more than seven times the size of the U.S. economy and 10 times the size of the outstanding national debt. The unfunded liability is the difference between the benefits that have been promised to retirees and what will be collected in dedicated taxes and Medicare premiums." (National Center for Policy Analysis)
Study Warns Job Losses Will Strain Government Health Programs
Excerpt: "Leading health researchers projected Monday that each percentage-point rise in unemployment during the economic downturn would swell the uninsured by 1.1 million, stoking demand for government health coverage just as states face pressure to cut benefits." (The New York Times; free registration required)
[Opinion] Providing Health Care for All Shouldn't Make Insurers Rich
Excerpt: "Government subsidies and outsourcing may be good for business without always being good for the public. Medicare outsources the administration of its prescription drug program, Medicare D, to private insurers. Medicare Advantage -- Medicare C -- subsidizes managed care insurance plans for seniors choosing them. Several current presidential aspirants -- Clinton and Obama -- would subsidize the purchase of insurance for the low-income uninsured. Each of these plans offers private insurers protection against a less wasteful plan, one that does without private insurers." (Herald Times via Physicians for a National Health Program)
SSA's Annual Statistical Supplement, 2007
Printed copies of this document are scheduled for release in mid-May 2008. (U.S. Social Security Administration)
Ultimatum to City of Duluth Retirees: Sign up for Medicare or Lose Coverage
Excerpt: "Thirty-seven city of Duluth retirees are getting letters in the mail saying they need to sign up for Medicare or lose their retiree health-care benefits. All city retirees who are eligible must sign up for Medicare. Mayor Don Ness said the 37 who have not done so were discovered during a review of the retiree health-care program last year. Once the retirees sign up, he said, the city stands to save $400,000 to $600,000 a year." (Duluth News-Tribune via NewsEdge via Human Resource Executive Online)
'The American Prospect' Special Report Focuses on U.S. Health Care System
Excerpt: "The May 2008 issue of The American Prospect features a special report on health care issues in the U.S. [Issues covered include state reform efforts; medical debt; and Medicare.]" (Kaiser Family Foundation)
[Guidance Overview] CMS Releases 2009 Medicare Part D Benefit Parameters (PDF)
Excerpt: "The Centers for Medicare and Medicaid Services (CMS) has updated the Medicare Part D standard benefit parameters and the cost thresholds and limits for qualified retiree prescription drug plans for 2009." (Buck Consultants)
Medicare Part D Accounting Practice Note (PDF)
29 pages. Excerpt: "The purpose of this practice note is to assist actuaries involved in valuation, accounting, and financialreporting work relating to Medicare Part D products." (American Academy of Actuaries)
[Guidance Overview] CMS Announces Indexed Medicare Part D Amounts for 2009
Excerpt: "On April 7, 2008, the Centers for Medicare & Medicaid Services (CMS) announced the indexed Medicare Part D standard benefit and Retiree Drug Subsidy (RDS) amounts for 2009. This Capital Checkup features charts comparing the 2009 numbers and the 2008 numbers." (The Segal Group, Inc.)
CBO Chief Is Health Care Referee
Excerpt: "The CBO director, who started his four-year term in January 2007, is going beyond the traditional budget-Cassandra role, and analyzing causes and solutions. He has emphasized that the biggest driver of rising medical costs is the increasing use of new technology, not simply an aging population." (The Wall Street Journal)
Growing Disparities in Life Expectancy (PDF)
6 pages. Excerpt: "Increasing longevity, by itself, has clear implications for Social Security and Medicare expenditures. As beneficiaries live longer, they will receive benefits for a longer period, putting additional pressure on the programs' finances." (U.S. Congressional Budget Office)
Assessing the Impact of Coverage Gaps in the Medicare Part D Drug Benefit (PDF)
Excerpt: "This study illustrates how beneficiaries faced with the full cost of their prescriptions reduce their overall utilization, a phenomenon that may become more common with increasing out-of-pocket expenses. Over time it appears that the coverage gap may negatively affect those suffering from chronic conditions by exacerbating the hurdles they already face." (Changes in Health Care Financing & Organization)
[Guidance Overview] ERISA Plan's Prior Authorization and Plan Limits Requirements Preempt State Medicaid Demands for Payment If Procedures Not Followed
Excerpt: "Employer health plans that require prior authorization or impose plan limits on certain types of care need not repay State Medicaid plans when those state plans pay for Medicaid recipients' treatments that the employer plan would not have paid unless the plan participant had received prior authorization under the employer plan. But this rule applies only if the plan participant first files the claim with the employer health plan and receives the employer plan's denial of payment, according to U.S. Department of Labor Advisory Opinion 2008-03A, March 31, 2008." (Deloitte via BenefitsLink.com)
McCain Says Affluent Seniors Should Pay More for Medicare Drug Benefit
Excerpt: "Sen. John McCain will propose today that affluent seniors pay more for government-provided drug benefits as a way to control health-care spending . . . ." (The Washington Post; free registration required)
Boomers to Flood Medical System, According to Study
Excerpt: "The report from the [Institute of Medicine], an arm of the National Academy of Sciences, said: --There aren't enough specialists in geriatric medicine. --Insufficient training is available. --The specialists that do exist are underpaid. --Medicare fails to provide for team care that many elderly patients need." (AP via The New York Times; free registration required)
[Guidance Overview] Plans Required to Reimburse Medicaid Even if Participant Failed to Obtain Required Preauthorization for Services
Excerpt: "EBIA Comment: This opinion builds on Advisory Opinion 2005-05A, in which the DOL concluded that ERISA does not preempt state laws that authorize states to recoup Medicaid payments from a plan if the plan would have been liable to any third party before the Medicaid payment was made . . . . According to that advisory opinion, such state laws may be enforced 'notwithstanding the plan's procedural requirements governing participant benefit claims' (for instance, Medicaid does not have to comply with the plan's filing time limits)." (Employee Benefits Institute of America)
Medigap: What You Need to Know (PDF)
12 pages. Excerpt: "This policy brief presents a snapshot of private Medicare Supplement (Medigap) insurance in 2008. Changes in Medigap products and expanded Medicare private plan options established by the Medicare Modernization Act of 2003 (MMA) became effective January 1, 2006. While most of the traditional standard Medigap products are unchanged, in conjunction with making the new Medicare (Part D) prescription drug benefits available, the MMA prohibited the inclusion of prescription drug benefits in any newly-issued Medigap policy. In addition, two new higher cost-sharing Medigap products authorized by the MMA (Plans K and L) became available in 2006." (America's Health Insurance Plans)
Trends in Medigap Policies, December 2004 to December 2006 (PDF)
7 pages. Excerpt: "This paper presents findings from an analysis conducted by America's Health Insurance Plans (AHIP) on enrollment trends in Medicare Supplement (Medigap) insurance coverage, using year-end data for 2004 through 2006 from the National Association of Insurance Commissioners (NAIC). The NAIC dataset contains information on most Medigap policies in force in the U.S.,1 representing approximately 10 million covered lives with policies from nearly 250 carriers." (America’s Health Insurance Plans)
The Effect of Medicare Part D on Pharmaceutical Prices and Utilization
Excerpt: "This paper evaluates the effect of this program on the price and utilization of pharmaceutical treatments. Theoretically, it is ambiguous whether the expansion in insurance coverage would increase or reduce pharmaceutical prices. Insurance-induced reductions in demand elasticities would predict an increase in pharmaceutical firms' optimal prices. However, Part D plans could potentially negotiate price discounts through their ability to influence the market share of specific treatments. Using data on product-specific prices and quantities sold in each year in the U.S., our findings indicate that Part D substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients. Our results further suggest that the magnitude of these average effects varies across drugs as predicted by economic theory." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
Medicare Finds How Hard It Is to Save Money
Excerpt: "An ambitious three-year experiment to see whether the Medicare system could prevent expensive hospital visits for people with chronic conditions like congestive heart failure and diabetes has suggested that such an approach may cost more than it saves." (The New York Times; free registration required)
CMS Issues Final Rule on Electronic-Prescribing Standards Under Medicare Prescription Drug Benefit
Excerpt: "The rule establishes standards for the electronic transmission of information of the medications covered under the Medicare prescription drug plans of beneficiaries and the availability of generic versions of those treatments. The standards allow physicians and other health care providers, as well as pharmacies and Medicare prescription drug plan sponsors, to share information about medications taken by beneficiaries. In addition, the standards allow pharmacies to inform physicians and other providers when patients obtain their prescriptions. The rule does not require physicians, pharmacies and other providers to adopt e-prescribing to participate in Medicare." (Kaiser Family Foundation)
Medicare Part D 2008 Data Spotlight: Ten Most Common Brand-Name Drugs (PDF)
2 pages. Excerpt: "This Medicare Part D Data Spotlight examines the variation in coverage, cost sharing and utilization management tools for the 10 prescriptions most commonly used by Medicare beneficiaries, including treatments for cholesterol, cardiovascular health, osteoporosis, dementia, gastrointestinal reflux and ulcers." (Kaiser Family Foundation)
Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings (PDF)
7 pages. Excerpt: "This synthesis of key findings from analysis presented in a series of eight Medicare Part D 2008 Data Spotlights describes key features of stand-alone prescription drug plans offered in 2008 and trends since 2006. The synthesis covers a range of topics, including premiums, the coverage gap, benefit design, cost sharing, specialty tiers, formularies, utilization management, the top 10 brand-name prescription drugs, and the availability of low-income subsidy plans." (Kaiser Family Foundation)
Congress in no rush to fix Medicare and Social Security
Excerpt: "Lawmakers are preparing to get serious about the long-term solvency of America's Social Security and Medicare programs – but not until the next Congress convenes. The latest annual report on the prospects for Social Security and Medicare projects a $42.9 trillion shortfall over the next 75 years, at current levels of benefits and taxation. The message Congress is taking away from the report is that there's still time to build bipartisan consensus for reform." (The Christian Science Monitor)
[Guidance Overview] Coordinating Retiree Health Benefits with Medicare (PDF)
2 pages. (Milliman)
The links shown above have been gathered from the web by the editors at BenefitsLink.com. Each article's publisher is shown above in parentheses. Opinions expressed in each article are those of the article's publisher, not necessarily those of BenefitsLink.com, Inc. or any web site that displays these headlines in a "frame." You should contact the listed publisher for copyright information about any particular article or to inquire into the right to use the article in any manner.