Headlines about "Medicare and Medicaid"
Gathered from the web by the editors at BenefitsLink.com.
CMS's Summary of Proposed Mandatory Reporting Requirements Under the Medicare Secondary Payer Rule; Comments Requested
Excerpt: "Effective January 1, 2009, as required by the MMSEA, an entity serving as an insurer or third party administrator for a group health plan and, in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary must: (1) Secure from the plan sponsor and plan participants such information as the Secretary may specify to identify situations where the group health plan is a primary plan to Medicare; and (2) report such information to the Secretary in the form and manner (including frequency) specified by the Secretary." (International Foundation of Employee Benefit Plans)
Social Security and Medicare and Americans' Confidence in Their Retirement Future
Excerpt: "Academics, policymakers and the media have been sounding alarms about shortfalls ahead for Social Security and Medicare for some time now. And many Americans have taken their warnings to heart, according to Watson Wyatt's 2007 U.S. Survey of Older Employees' Attitudes Toward Lump Sum and Annuity Distributions From Retirement Plans. Roughly 61 percent of older workers -- those 50 to 64 years old -- are not confident of receiving unreduced Medicare benefits, and 52 percent are not confident of receiving unreduced Social Security benefits, according to the survey." (Watson Wyatt Worldwide)
[Opinion] Mother's Day - May 2008: Addendum to the 2007 Mother's Day Report - Medicare for All
4 page Microsoft document. (Older Women's League)
[Guidance Overview] CMS Summary of Proposed Mandatory Insurer Reporting Requirements
Excerpt: "This issue summarizes information recently published by the Centers for Medicare & Medicaid Services about the implementation of new data-collection rules that will affect employer-sponsored group health plans starting January 1, 2009." (The Segal Group, Inc.)
[Guidance Overview] CMS Taking Steps to Implement New Medicare Secondary Payer Reporting Requirements
Excerpt: "The Centers for Medicare and Medicaid Services (CMS) has set up a Web site to facilitate implementation of new mandatory reporting requirements relating to the Medicare Secondary Payer (MSP) rules for group health plans. The CMS Web site can be accessed at www.cms.hhs.gov/MandatoryInsRep. The new reporting requirements will be implemented on January 1, 2009, and the CMS's Web site will be a 'one-stop shop' for all relevant implementation and compliance materials." (Deloitte)
The Medicare Part D Coverage Gap: Costs and Consequences in 2007
Excerpt: "This study quantifies, for the first time, the number of Medicare Part D plan enrollees in 2007 who reached a gap in their prescription drug coverage known as the 'doughnut hole,' as well as the changes in beneficiaries' use of medications and out-of-pocket spending after they reached that gap. The analysis excludes beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan." (Kaiser Family Foundation)
[Guidance Overview] CMS Posts Mandatory Reporting Guidance on Website
Excerpt: "EBIA Comment: Group health plan sponsors are likely to appreciate the 'one-stop shopping' website approach for guidance about how to comply with this new mandate. However, in addition to becoming familiar with the new guidance, it's also important to stay tuned! CMS indicates that future implementation details on the website will include a registration process, user guides for submitting data, and a suggested model form for collecting Medicare beneficiary information." (Employee Benefits Institute of America)
[Opinion] Maximum Coverage As Defined by Anthem Blue Cross
Excerpt: "Letter From: Anthem Blue Cross, Oxnard, California . . . Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. . . . What's this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system." (Physicians for a National Health Program)
[Guidance Overview] New Medicare Secondary Payer Reporting Requirements
Excerpt: "The Medicare, Medicaid, and SCHIP Extension Act of 2007 (the 'Act') will require group health plan insurers, third‑party administrators, and some plan administrators and fiduciaries to comply with new Medicare Secondary Payer ('MSP') reporting requirements effective January 1, 2009." (Dorsey & Whitney LLP)
Medicare Secondary Payer — Coordination of Benefits (PDF)
18 pages. Excerpt: "Under certain conditions, the law makes Medicare the secondary payer to insurance plans and programs for beneficiaries covered through (1) a group health plan based on either their own or a spouse's current employment; (2) auto and other liability insurance; (3) no-fault liability insurance; and (4) workers' compensation situations, including the Black Lung program. The purpose of the MSP program is to shift costs from Medicare to private sources of payment, thus reducing Medicare expenditures." (U.S. Congressional Research Service)
Medicare Drug Plan Monthly Premiums Up About 12% for 2009
Excerpt: "The typical Medicare beneficiary can expect to see about a $3 increase in their monthly premiums for prescription drug coverage in 2009, federal officials said Thursday. Officials made the projection based on bids from private insurers that get the premiums along with a federal subsidy to administer the benefit. The increase of 12% will up the monthly premium to $28 for standard drug coverage." (USA TODAY)
No Help Coming for Massachusetts City's Retiree Medicare Cost
Excerpt: "It looks like Worcester's municipal retirees will not be getting help from the city anytime soon when it comes to paying their Part B Medicare costs. City Manager Michael V. O'Brien said there is no 'fiscally feasible means' for the city to pick up the tab for any portion of the retirees' Part B Medicare costs without a reduction in municipal services or raising property taxes." (Worcester Telegram & Gazette Corp.)
Kucinich Introduces Legislation That Seeks To Lower Prescription Drug Costs by Replacing Medicare Part D
Excerpt: "Rep. Dennis Kucinich (D-Ohio) recently introduced a bill (HR 6800) that would replace the Medicare prescription drug benefit with a new program in an effort to reduce costs, CQ HealthBeat reports. The legislation would require Medicare to negotiate directly with pharmaceutical companies for discounts on prescription drugs and eliminate copayments, premiums and deductibles for medications for beneficiaries." (Kaiser Family Foundation)
[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)
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