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Medicare and Medicaid

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2018 Medicare Parts A and B Premiums and Deductibles
"The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in 2017.... CMS estimates that the Medicare Advantage average monthly premium will decrease by $1.91 (about 6 percent) in 2018, from an average of $31.91 in 2017 to $30. More than three-fourths (77 percent) of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
How Does Health Care Fare in Congress' Attempts to Simplify the Tax Code?
"While the direct impact of tax reform on health care costs is still unknown, the federal budget resolution passed last month recommends a $1.8 trillion reduction in health care spending, including a $1.3 trillion cut to non-Medicare health programs and another $473 billion cut to Medicare over the next 10 years.... [A]ny decrease in public funding for health care will likely shift expenses to privately sponsored health insurance coverage." (The Alliance)
[Opinion] What's Causing America's Rural Health Insurance Crisis?
"Rural areas have long posed a special challenge to health care policymakers, but a poorly-designed system of subsidies for rural hospital care has turned this into a crisis. It has fostered a rural hospital market structure that has crippled the ability of private insurers to negotiate reasonable payment rates, without fully securing the provision of essential care. By refocusing federal assistance on emergency care, it should be possible to restore rural insurance markets to health, while improving the affordability and access to care available to residents." (Manhattan Institute for Policy Research)
A New Plan to Rescue the ACA: Medicare-at-55
"Under this proposal, Medicare-at-55 would be universal for people in the 55-64 age group and they would leave their current private insurance. It would require an increase in the Medicare payroll tax contribution ... Medicare-at-55 is quite different from proposals suggested by Democrats in 2009 and 2017, which allowed people aged 55-64 to voluntarily buy into Medicare as an alternative to private insurance.... While the 55-64 age group has higher health care costs than younger people, they have lower costs than current Medicare beneficiaries[.]" (Health Affairs)
Medicare Offers More Health Coverage Choices and Decreased Premiums in 2018
"[T]he average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high. Earlier this year, CMS announced new policies that support increased benefit flexibilities allowing Medicare Advantage plans the ability to offer innovative plans that fit the needs of people with Medicare." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Guidance Overview] CMS Announces Special Enrollment Periods for Americans Impacted by Recent Hurricanes
"As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare & Medicaid Services (CMS) will make available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange.... In addition to the special enrollment periods for the 2017, individuals who reside in or move from areas affected by a hurricane in 2017 will be eligible for a special enrollment period that extends the 2018 Annual Open Enrollment Period through December 31, 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Medicare and HSA Eligibility
"Simply gaining eligibility for Medicare doesn't disqualify employees from staying on your high deductible plan or from contributing into an HSA.... Enrollment in Medicare (Parts A, B, C, or D), versus becoming eligible for Medicare, disqualifies an employee from making or receiving contributions to an HSA. However, enrollment in Medicare does not impact their eligibility to enroll in the HDHP, as HSAs are independent offerings from a HDHP, or request reimbursement from their HSA.... To avoid penalties, older workers should be advised to stop contributing to their HSA account six months before applying for their Social Security benefits." (HUB International)
[Opinion] How the Bernie Sanders Plan Would Both Beef Up and Slim Down Medicare
"In his big new single-payer health care bill, Senator Bernie Sanders says he wants to turn the country's health system into 'Medicare for all.' But his bill actually outlines a system very different from the current Medicare program.... [It] would make it more generous than it has ever been, expanding it to cover new types of benefits and to erase most direct health care costs for consumers.... The changes are intended to make the health care system more affordable, but the details could have big effects on what sorts of care might be developed and made available." (Margot Sanger-Katz, in the New York Times; Subscription May Be Required)
Deadline Nears for Medicare Part D Creditable/Non-Creditable Coverage Notices (PDF)
"Plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals before each year's Medicare Part D annual enrollment period -- this year, by October 14, 2017. The notice obligation is not limited to retirees and their dependents but also includes Medicare-eligible active employees and their dependents and Medicare-eligible COBRA participants and their dependents." (Conduent)
Retiree Health Costs Surge
"The estimate for retiree health care spending rises to an average of $275,000 per couple, excluding long-term care expenses. This is an increase of $15,000 from 2016. Health care continues to be one of the largest expenses in retirement.... And that applies only to retirees with traditional Medicare insurance coverage, and does not include costs associated with nursing home care." (Fidelity)
[Opinion] Curbing Prescription Drug Prices Through the PBM Model
"PBMs can play a critical role in keeping costs in check and ensuring affordable access for all beneficiaries.... [W]ithout PBMs, [Medicare] premiums would be 66 percent higher. Because of PBMs, the Part D program will save more than $1,800 per year per beneficiary ... The savings that PBMs generate for Part D are also highly encouraging for the employers, unions, health plans and others in the private sector working to keep prescription drug costs in check for their employees and members." (Meghan Scott, via Morning Consult)
CMS Issues Part D Premiums for 2018
"The average premium for a basic Medicare Part D prescription drug plan in 2018 will be $33.50 per month, which is a decrease from $34.70 in 2017 ... The decline in the average premium comes despite the fact that spending for the Part D program continues to increase faster than spending for other parts of Medicare, largely driven by spending on high-cost specialty drugs." (Wolters Kluwer Law & Business)
[Opinion] Making the Exchanges More Competitive by Bringing Medicare Into the Fold
"Introducing Medicare wouldn't require significant new spending. It would provide competition in counties with only one or two insurers. And it would ensure that all counties would always have at least one insurance option available. What's more, Medicare could be used to provide new private plan options by allowing Medicare Advantage private plans to offer coverage to nonelderly Americans through the exchanges." (Gerard Anderson, Jacob S. Hacker, and Paul Starr, in Health Affairs)
Under Trump, Hospitals Face Same Penalties Embraced by Obama
"Amid all the turbulence over the future of the [ACA], one facet continues unchanged: President Donald Trump's administration is penalizing more than half the nation's hospitals for having too many patients return within a month. Medicare is punishing 2,573 hospitals, just two dozen short of what it did last year under former President Barack Obama ... Starting in October, the federal government will cut those hospitals' payments by as much as 3 percent for a year." (Kaiser Health News)
[Official Guidance] Medicare Projects Decrease in Drug Premiums for 2018
"[CMS has] announced that the average basic premium for a Medicare Part D prescription drug plan in 2018 is projected to decline to an estimated $33.50 per month. This represents a decrease of approximately $1.20 below the actual average premium of $34.70 in 2017.... The decline in the average premium comes despite the fact that spending for the Part D program continues to increase faster than spending for other parts of Medicare, largely driven by spending on high-cost specialty drugs." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
2016 Health Insurance Enrollment: Private Coverage Declined, Medicaid Growth Slowed (PDF)
"During 2016, individual-market enrollment decreased by 583,000 individuals and employer-group coverage decreased by 4,000 individuals for a net decrease in private-market coverage of 587,000 persons. For the employer-group coverage market, enrollment in fully insured plans decreased by 1.049 million individuals; enrollment in self-insured plans increased by 1.045 million individuals. The net effect was a decrease of 4,000 in the number of individuals with employer-sponsored coverage in 2016." (The Heritage Foundation)
Medicare's Financial Condition: Beyond Actuarial Balance (PDF)
"The projected [hospital insurance (HI)] deficit over the next 75 years is 0.64 percent of taxable payroll. Eliminating this deficit would require an immediate 22 percent increase in standard payroll taxes or an immediate 14 percent reduction in expenditures -- or some combination of the two. Delaying action would require more severe changes in the future." (American Academy of Actuaries)
Medicare Trustees: Fund Is Solvent Through 2029
"[The 2017 Medicare Trustees report projects] that the trust fund financing Medicare's hospital insurance coverage will be depleted in 2029, one year later than projected in last year's report. Lower spending in 2016, lower projected inpatient hospital utilization and slightly better projected hospital insurance deficit in 2017 than in 2016 were the contributing factors ... [B]ecause spending levels in Medicare did not exceed its targets, the Independent Payment Advisory Board (IPAB), set up by the (ACA), was not triggered." (U.S. Department of Health and Human Services [HHS])
[Guidance Overview] IRS Form 14581-C: Medicare Coverage Compliance Self-Assessment for State and Local Government Employers (PDF)
"The self-assessment tools are designed to help public employers identify areas that indicate potential compliance issues. They are intended to be completed by those responsible for withholding and paying employment taxes and filing required information returns." [June 2017] (Internal Revenue Service [IRS])
CBO Report: Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending
"In CBO's assessment, Medicaid spending under the Better Care Reconciliation Act of 2017 would be 26 percent lower in 2026 than it would be under the agency's extended baseline, and the gap would widen to about 35 percent in 2036 ... [O]verall Medicaid spending would grow 5.1 percent per year during the next two decades, in part because prices for medical services would increase. Under this legislation, such spending would increase at a rate of 1.9 percent per year through 2026 and about 3.5 percent per year in the decade after that." (Congressional Budget Office [CBO])
2017 Retirement Health Care Costs Data Report (PDF)
"[A] 66-year-old couple retiring this year will require 59% of their Social Security benefits to cover total retirement health care costs. A 55-year-old couple will need 92% of benefits, and 45-year-old couple, 122%.... [A] 65-year-old couple will pay $404,253 ($607,662 in future dollars) for total lifetime health care costs.... [In] ten years, a 55-year-old couple will pay 25% more for the same coverage. In two decades, equivalent insurance will cost a 45-year-old couple over $635,000." (HealthView)
Two States Make Strong Statements About Their ACA Markets
"The bold actions of New York and Nevada probably do not signal a national trend in the short run. Both are in the minority of states that run their own Exchange ... so they have more control over their Exchange markets than most states.... The Trump administration is committed to empowering states, and Medicaid and Exchange markets are more alike than different. Given this -- and absent large Medicaid cuts that could trigger insurer exits from that market -- more states may be tempted to link the Medicaid and Exchange markets[.]" (Faegre Baker Daniels LLP)
Proposed Legislation Would Expand Medicare Coverage of Telehealth Services
"The Telehealth Improvement Act would require the Center for Medicare and Medicaid Innovation (CMMI) to test the effect of including telehealth services in Medicare health care delivery reform models. More specifically, the Act would require CMMI to assess telehealth models for effectiveness, cost and quality improvement, and if the telehealth model meets these criteria, then the model will be covered through the Medicare program." (McDermott Will & Emery, via General Counsel News)
Prescription Drug Price Rebates May Raise Out-of-Pocket and Federal Spending
"Proponents argue that rebates result from vigorous negotiations that help lower overall drug costs. Critics argue that rebates have perversely increased the costs patients pay out of pocket, as well as the costs for Medicare as a whole. This [article] discusses how the availability of rebates for drugs covered by the Medicare Part D program may raise costs for patients and Medicare while increasing the profits of Part D plan sponsors and pharmaceutical manufacturers. Two policy alternatives are herein proposed that would reconfigure cost sharing to lower patient out-of-pocket costs and reduce cost shifting to Medicare." (The JAMA Network)
[Opinion] Efforts to Shore up MassHealth Should Favor Simplicity and Avoid Potential Conflict with Federal Law
"In an effort to make up for a funding shortfall in the Commonwealth of Massachusetts' Medicaid program, state policymakers have proposed solutions that include a 'play-or-pay' option under which employers who fail to offer major medical coverage ... would be required to pay an additional 'employer contribution' to the Commonwealth based on multiple factors and complex computations.... The 'play-or-pay' option would not only be extremely complicated to comply with and enforce, ... it may be preempted by [ERISA]." (Mintz Levin)
[Opinion] NCPA Offers House Committee Suggestions to Enhance Medicare, Increase Access to Prescription Drugs
"NCPA recommended the following: [1] Enact H.R. 1038 (the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act). The legislation would ban retroactive direct and indirect remuneration (DIR) fees on community pharmacies. [2] Strengthen and finalize proposed CMS guidance on DIR and pharmacy price concessions. [3] Review and standardize how Part D plans measure pharmacy quality and performance in community pharmacies. [4] Enact H.R. 1316 (the Prescription Drug Price Transparency Act) to increase transparency into how generic drugs are priced by PBMs and paid for in Medicare." (National Community Pharmacists Association [NCPA])
American Health Care Act Would Affect Key Components of Medicare
"Low-income Medicare beneficiaries who also are enrolled in Medicaid -- often referred to as 'dual eligibles' -- could be disproportionately affected by congressional efforts to cut and cap federal Medicaid financing. Not only do these older adults account for one-third of all Medicaid spending, much of the Medicaid spending for low-income Medicare beneficiaries is 'optional' for states." (The Commonwealth Fund)
Did Medicare Part D Reduce Mortality?
"[The authors] investigate the implementation of Medicare Part D and estimate that this prescription drug benefit program reduced elderly mortality by 2.2% annually. This was driven primarily by a reduction in cardiovascular mortality, the leading cause of death for the elderly. There was no effect on deaths due to cancer, a condition whose drug treatments are covered under Medicare Part B.... [T]he value of the mortality reduction is equal to $5 billion per year." (Journal of Health Economics; purchase required)
IRS Information Letter Addresses HSA Ineligibility Due to Medicare Entitlement
"Medicare entitlement is automatic for some individuals ... Other individuals must file an application to be entitled to benefits (e.g., working individuals beyond age 65 who are eligible to receive Social Security benefits but who have not applied for them). Employers rehiring retirees should be aware of these rules and avoid setting up HSAs for Medicare-entitled employees. Excess pre-tax contributions to a preexisting HSA caused by failing to recognize an employee's ineligibility could trigger an additional 6% excise tax ... if the amounts are not timely distributed." (Thomson Reuters / EBIA)
How Medicaid Enrollees Fare Compared with Privately Insured and Uninsured Adults
"[T]he large majority of people who have Medicaid for the full year are able to get the health care they need. Based on survey results, 91 percent have a regular source of care, compared to 93 percent of privately insured people with continuous coverage and 77 percent of people uninsured for at least part of the year. Medicaid enrollees are also happy with their care -- 57 percent rated it as very good or excellent, compared with 52 percent of the privately insured and 40 percent of the uninsured." (The Commonwealth Fund)
GAO Report: Telehealth and Remote Patient Monitoring Use in Medicare and Selected Federal Programs
72 pages. "The Medicare Access and CHIP Reauthorization Act of 2015 includes a provision for GAO to study telehealth and remote patient monitoring. Among other reporting objectives, this report reviews [1] the factors that associations identified as affecting the use of telehealth and remote patient monitoring in Medicare and [2] emerging payment and delivery models that could affect the potential use of telehealth and remote patient monitoring in Medicare." [GAO-17-365, published and released Apr. 14, 2017] (U.S. Government Accountability Office [GAO])
Justice Department Joins Lawsuit Alleging Massive Medicare Fraud by UnitedHealth
"The Justice Department has joined a California whistleblower's lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.... [The whistleblower] has accused the insurer of 'gaming' the Medicare Advantage payment system by 'making patients look sicker than they are' said his attorney ... [The attorney] said the combined cases could prove to be among the 'larger frauds' ever against Medicare, with damages that he speculates could top $1 billion." (Kaiser Health News)
What's in the Manager's Amendment to the American Health Care Act?
"It consists of two sets of amendments, labeled technical changes ([ with an accompanying summary]) and policy changes ([with an accompanying summary]).... The amendments add an additional year to the relief the AHCA offered from the 'Cadillac' plan excise tax ... and accelerate the repeal of all other ACA taxes from 2018 to 2017.... Another provision clarifies that the 30 percent of premium penalty imposed on consumers who seek coverage after a gap in coverage applies only in the individual and not in the small group market.... [M]uch of the $337 billion in deficit reduction that the CBO credited to the AHCA disappears under the manager's amendment." (Health Affairs)
House Republicans Announce Updates to Strengthen American Health Care Act
"To provide more immediate help, the amendment accelerates repealing the Obamacare taxes to 2017, rather than 2018.... Under current law, Americans can deduct from their taxes the cost of medical expenses that exceed 10 percent of their income. Our proposed amendment reduces this threshold to 5.8 percent of income.... This amendment would allow states to opt out of the per capita [Medicaid] allotment baseline and instead receive federal funds through a block grant.... [T]he amendment would prevent new states from opting in to Obamacare's Medicaid expansion." (Committee on Ways and Means, U.S. House of Representatives)
The Unfolding Medicaid Story: Congress, Governors, and the Trump Administration
"Over a half century, federal and state policymakers alike have turned to Medicaid because its flexible structure repeatedly has offered the ability to nimbly respond to social problems as they emerge ... Thus, how to change Medicaid's growth trajectory without weakening its unique and indispensable qualities represents perhaps the most significant of all U.S. health policy challenges. The rest of the nation's intensely market-driven system, as well as Medicare, rests on Medicaid's features and capabilities. The debate over Medicaid is now playing out on three fronts." (Health Affairs)
House GOP Health Plan Would Accelerate Depletion of Medicare Trust Fund by Four Years
"The House bill to repeal the [ACA] would move up the Medicare's Hospital Insurance trust fund's depletion from 2028 to 2024. Repealing a payroll tax on high earners would advance the depletion date by three years ... Additional Medicare payments to hospitals that serve many uninsured payments would advance it one more year[.]" (Center on Budget and Policy Priorities)
State Retirement Savings Initiatives Can Enhance Retirement Security for Private Sector Workers and Offset the Cost of Medicaid (PDF)
"The result of the analysis showed a positive correlation between increased retirement savings, sufficient to remove a percentage of currently vulnerable households from the poverty rolls by the time they retire, and a reduction in Medicaid spending. [A table] shows estimated savings in Medicaid payments by states and the District of Columbia for the first 10 years after a retirement savings program is introduced. Over that period, 15 states would save more than $100 million each, with total projected savings if available in all states approaching $5 billion in the first 10 years." (Segal Consulting)
House Panel Calls for Medicaid Work Requirement, Tax Credit Changes in Health Bill
"Three of the motions, which passed along party lines, were aimed at establishing requirements for Medicaid enrollment, while a fourth would allow more generous tax credits to help low-income people afford insurance. The motions were nonbinding recommendations that could be proposed on the House floor as amendments or incorporated into the bill, the American Health Care Act, when it goes before the Rules Committee ... The recommendations came after the committee at the outset of the meeting narrowly voted to advance the bill, 19-17[.]" (U.S. News & World Report)
Improvements in Access and Quality Nationwide Following ACA's Major Coverage Expansions
"The uninsured rate among low-income working-age adults dropped an average of 14.1 percentage points in states that expanded Medicaid, compared to 8.9 points in nonexpansion states. The percentage of low-income adults who said they went without care because of its cost dropped an average of 5.5 points in expansion states compared to 2.3 points in nonexpansion states.... Some Medicaid expansion states saw gains beyond coverage." (The Commonwealth Fund)
[Opinion] Sensible Medicare and Federal Employees Health Benefits Reform for All Annuitants
"The Postal Service Reform Act of 2017 (H.R. 756) would force postal annuitants to buy Medicare insurance they neither need nor want. The Postal Service does need to address a serious retiree health care prefunding obligation imposed by Congress over a decade ago. But the problem can be resolved without forcing seniors to purchase insurance they do not need or want." (The Heritage Foundation)
Medicare Premium Support Proposals Could Increase Costs for Today's Seniors, Despite Assurances
"[P]roponents would split Medicare into two parts: one for people now over age 55 who would be 'grandfathered' into the current Medicare program, and one for younger adults, now 55 or younger, who would get coverage under the new premium support system once they became eligible for Medicare.... Once the system is fully implemented, younger, healthier, and lower-cost beneficiaries, those now 55 and younger, would be cut off -- at least actuarially -- from older, sicker, and more expensive beneficiaries, those now 55 and older.... [T]he increased rate of cost growth in the current system would result in higher premiums, deductibles, and cost-sharing for those covered by it: today's seniors and near-seniors." (Health Affairs)
[Opinion] Why Living Longer Should Not Lead to Medicare Benefit Cuts
"[A] new report [analyzes] the impact of raising the Medicare eligibility age from 65 to 67 ... The findings are grim: soaring rates of uninsured people age 66 and 67, worsened health outcomes and rising use of expensive emergency medical services." (Reuters)
The American Health Care Act: House Energy and Commerce Committee Provisions (PDF)
"The legislation, part of House Republicans' American Health Care Act, ... [1] Creates a Patient and State Stability Fund -- This new and innovative fund give states broad flexibility to design programs that best serve their unique populations. They can also use funds to increase access to preventative services. [2] Responsibly unwinds Obamacare's Medicaid expansion -- By freezing new enrollment after 2 years and grandfathering in current enrollees, we protect patients and offer a stable transition. [3] Strengthens Medicaid -- Using a per capita allotment, our legislation ensures a fair funding formula for states while creating a viable financial future for the program." (Energy and Commerce Committee, U.S. House of Representatives)
[Opinion] Medicaid Caps: The Threat Below the Surface
"President Trump and Republican leaders are actively considering voucherizing Medicare and converting Medicaid financing into a block grant or per capita cap. This [article] focuses on the efforts to undermine Medicaid and the voucherization of Medicare." (National Health Law Program [NHeLP])
Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by 'Hundreds of Millions'
"The suit accuses United of operating an 'up-coding' scheme to receive higher payments under [Medicate Advantage's] risk adjustment program ... The complaint alleges that United fraudulently collected 'hundreds of millions -- and likely billions -- of dollars' by claiming patients were sicker than they really were." (Sheppard Mullin)
Creditable Coverage Disclosures Are Due to CMS by March 1
"Plan sponsors generally must disclose creditable coverage status to CMS within 60 days after the beginning of each plan year.... An entity that does not offer outpatient prescription drug benefits to any Part D-eligible individual on the first day of its plan year is not required to complete the CMS disclosure form for that plan year." (Society for Human Resource Management [SHRM])
How Much Should a Medicare Beneficiary Save for Health Expenses? Some Couples Need $350,000 (PDF)
"In 2016, a 65-year-old man would need $72,000 in savings and a 65 year-old woman would need $93,000 if each had a goal of having a 50 percent chance of having enough savings to cover health care expenses in retirement.... A couple with median prescription drug expenses would need $165,000 if they had a goal of having a 50 percent chance of having enough savings to cover health care expenses in retirement.... For a couple with drug expenses at the 90th percentile throughout retirement who wanted a 90 percent chance of having enough money saved for health care expenses in retirement by age 65, targeted savings would be $349,000 in 2016." (Employee Benefit Research Institute [EBRI])
[Guidance Overview] Medicare Updates Affect Employer Reporting Requirements
"[F]rom April 1, 2018 through December 31, 2019, CMS will begin issuing Medicare Beneficiary Identifiers (MBI) to replace the Social Security Number (SSN) based Health Insurance Claim Number (HICN) currently in use.... For all settlements with Medicare beneficiaries that have the impact of releasing medical care issues, employers and/or insurers should request the MBI to use when reporting the settlement to CMS or determining its potential reimbursement interests based on conditional payments." (Ice Miller LLP)
How COBRA Intersects with Medicare and Retiree Health Plans
"If an employer offers retiree health coverage that is a non-COBRA alternative to COBRA coverage for eligible retirees, then the retirees are still considered 'covered employees' for COBRA purposes." (HR Daily Advisor)
State Retirement Savings Initiatives Do More Than Enhance Retirement Security for Private Sector Workers (PDF)
"As states look at programs to build retirement savings, they are also asking how a population better prepared for retirement would affect public safety-net programs.... [An] analysis showed a positive correlation between increased retirement savings sufficient to remove a percentage of currently vulnerable households off the poverty rolls by the time they retire, and a reduction in Medicaid spending." (Segal Consulting)
[Guidance Overview] Calendar Year Health Plans Must Complete Online CMS Disclosure by March 1
"The plan sponsor must complete the disclosure within 60 days after the beginning of the plan year if it has any employees or dependents eligible for and receiving Part D prescription drug benefits.... Employer plans that do not offer drug coverage to any Medicare-enrolled employee, retiree or dependent at the beginning of the plan year are exempt from filing." (Kushner & Company)
[Guidance Overview] Calendar Year Health Plans Must Complete Online CMS Disclosure by March 1 (PDF)
"The plan sponsor must complete the disclosure within 60 days after the beginning of the plan year. (Sponsors of insured plans may apparently choose to file within 60 days after the beginning of the insurance contract year, but whatever approach they adopt, they should use that approach consistently.) ... A CMS filing is also required within 30 days of termination of a prescription drug plan and for any change in a plan's creditable coverage status. Some plans are exempt from the filing requirement." (Lockton Benefit Group)
[Guidance Overview] Medicare Part D Disclosures Due By March 1 For Calendar Year Plans (PDF)
"This disclosure requirement applies when an employer-sponsored group health plan provides prescription drug coverage to individuals who are eligible for coverage under Medicare Part D. The plan sponsor must complete the online disclosure within 60 days after the beginning of the plan year. For calendar year health plans, the deadline for the annual online disclosure is March 1." (Cowden Associates, Inc.)
[Official Guidance] Text of CMS State Innovation Waiver Approval Letter for Hawai'i (PDF)
"Hawai'i's application sought waiver of the ACA requirement that a [SHOP] operate in Hawai'i and other related provisions relevant to SHOP Exchanges. Under this waiver ... [certain enumerated] provisions of the ACA are waived in Hawai'i ... The Departments deny Hawai'i's request to waive section 131 l(t)(3)(B) to seek flexibility to permit state agencies other than the State Medicaid Agency to have a role in an Exchange ... Given that a Federally-facilitated Marketplace operates in Hawai'i, this provision will not be a part of the waiver." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
How COBRA Intersects with Medicare and Retiree Health Plans
"If an employer offers retiree health coverage that is a non-COBRA alternative to COBRA coverage for eligible retirees, then the retirees are still considered 'covered employees' for COBRA purposes. Furthermore, the Medicare statutory rules allow employer-sponsored group health plans to reduce or terminate coverage if retired employees become entitled to Medicare. Thus, if a covered retiree becomes entitled to Medicare, and that entitlement would cause a loss of coverage for his or her spouse and dependents under the terms of the employer's retiree coverage, then a qualifying event has occurred." (HR Daily Advisor)
[Guidance Overview] CMS Acts on Premium Payments by Dialysis Facilities, Special Enrollment Period Eligibility
"Comments [received by CMS] suggested that facilities are paid four times as much by commercial than by public payers, allowing them to make as much as $100,000 to $200,000 more per year per patient. But premiums for individual market coverage only cost $4,200 per year; thus, there is an incentive for the providers to steer their patients to commercial coverage and pay the full premium.... CMS has concluded that this practice can be harmful to consumers." (Timothy Jost, in Health Affairs)
[Official Guidance] Text of CMS Interim Final Rule: Conditions for Third-Party Payment of Individual Health Plan Premiums by Medicare-Certified Dialysis Facilities
63 pages. "Dialysis facilities subject to the new standard will be required to make patients aware of potential coverage options and educate them about the benefits of each to improve transparency for consumers.... [F]acilities must ensure that issuers are informed of and have agreed to accept the payments.... [CMS is] considering whether it would be appropriate to prohibit third party premium payments for individual market coverage completely for people with alternative public coverage." [Fact Sheet also available.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
In Antitrust Trial, Justice Department Questions Aetna-Humana Asset Sale Plan
"The [DOJ], which is suing to block the merger, questioned the ability of the proposed asset buyer, California-based Molina Healthcare Inc., to keep the market for private Medicare plans for senior citizens competitive if Aetna and Humana combine.... Justice Department lawyer Ryan Kantor said Molina's own documents showed that its board members had concerns about the wisdom of buying assets from Aetna and Humana." (The Wall Street Journal; subscription may be required)
The Enrollees Who Actually Didn't Even Need Obamacare
"[A]bout 70 percent of the decline in the number of uninsured people [can be attributed to] three factors: the subsidies for buying insurance; the law's more generous criteria for Medicaid eligibility; and the 'woodwork effect,' in which people who were previously eligible for Medicaid 'came out of the woodwork' and signed up for the program in 2014.... The largest effect was due to that woodwork effect -- about 44 percent of the effect they can explain, or roughly 30 percent of the overall reduction in the number of uninsured in 2014. Call it 3.3 million people, out of the 11.6 million who gained insurance that year." (Bloomberg)
[Guidance Overview] CMS Announces 2017 Medicare Parts A & B Premiums and Deductibles
"Because of the low Social Security COLA, a statutory 'hold harmless' provision designed to protect seniors, will largely prevent Part B premiums from increasing for about 70 percent of beneficiaries. Among this group, the average 2017 premium will be about $109.00, compared to $104.90 for the past four years. For the remaining roughly 30 percent of beneficiaries, the standard monthly premium for Medicare Part B will be $134.00 for 2017, a 10 percent increase from the 2016 premium of $121.80. Because of the 'hold harmless' provision covering the other 70 percent of beneficiaries, premiums for the remaining 30 percent must cover most of the increase in Medicare costs for 2017 for all beneficiaries." For detailed official announcements of the 2017 amounts see: [1] Medicare Part A Premiums; [2] Medicare Part B Premiums and Deductibles; and [3] Medicare Inpatient Deductible and Coinsurance Amounts. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

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