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News Items, by Subject

Medicare and Medicaid

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[Guidance Overview] Telehealth Reimbursement May Be Coming to Medicare: CMS Proposes Medicare Payment for Virtual Visits and Review of Pre-Recorded Images
"[CMS], for the first time, has proposed payment for virtual visits to established patients regardless of such patients' location, effective January 1, 2019.... CMS is seeking comment on the types of communication technology that may be used in furnishing the virtual services, including whether audio-only telephone interactions are sufficient compared to interactions that are enhanced with video or other kinds of data transmission." (Drinker Biddle)
Medicare Billing Overhaul to Transform Documentation, Expand Telehealth
"Rather than continuing to comply with documentation guidelines from the 1990s, practitioners would be able to choose to document [Evaluation and Management ('E&M')] visits based on time spent with the patient or on their own medical decision-making.... Rather than having to re-document information from past visits, practitioners would have more options to simply review and update existing documentation. Physicians would further be allowed to simply review and verify certain medical records that staff members or the patient entered." (HealthLeaders Media)
Prescription Drug Costs Retirees Should Expect to Pay
"The majority of Medicare Part D plans (55 percent) have a deductible before medications will be covered.... Medicare Part D plans have a formulary, or list of covered medications. These medications are typically grouped into tiers that have different costs for plan participants.... Retirees who need to take medications classified as non-preferred brand name drugs or specialty drugs often need to pay coinsurance, or a percentage of the price of the medicine." (U.S. News & World Report)
HSA Eligibility for Retirement-Age Individuals
"[W]hen an individual who is 65 commences Social Security benefits, that individual is automatically enrolled in Medicare Part A.... [O]nce an employee or spouse is enrolled in Medicare Part A, they are no longer eligible to make contributions to an HSA. To complicate the contribution calculation, in the year an employee turns age 65 and commences Social Security benefits, enrollment in Medicare Part A will apply retroactively up to six months." (Benefits Bryan Cave)
Who Must Get a Medicare Part D Disclosure Notice?
"A 'Part D eligible individual' is an individual who [1] is entitled to benefits under Medicare Part A or enrolled in Medicare Part B; and [2] lives in the service area of a Part D plan. Part D eligible individuals could include active employees, disabled employees, COBRA participants, retirees, and, importantly, covered spouses and dependents of any of the above." (Thomson Reuters / EBIA)
Retiree Healthcare Back in Focus
"[E]mployer plan eligibility rules must be amended to include any class of employees not actively at work or the plan may find itself with uncovered stop loss claims. If the employer prepares its reporting under Generally Accepted Accounting Principles, rules require that the cost of retiree benefits be accrued in the year the liability arises (i.e. during the working years) and actuarial studies are required." (Frenkel Benefits)
[Opinion] The Myth of Medicare's Projected Insolvency
"Every year the Medicare trustees project the year in which the funds for Part A of Medicare will be inadequate to pay the full costs for that year, based on anticipated revenue and spending. Each year the media then report the pending insolvency of Medicare. This is nonsense." (Physicians for a National Health Program [PNHP])
Medicare Trustees Report Shows Lower Spending Projections for Medicare Part D
"[In the 2018 Annual Report to Congress, the Medicare Trustees said] Part D drug spending projections are lower than in last year's report because of higher manufacturer rebates, a decline in spending for Hepatitis C drugs, and a slowdown in spending growth for diabetes drugs.... [T]he Trust Fund will be able to pay full benefits until 2026, which is three years earlier than last year's projections ... [T]otal Medicare costs ... will grow from approximately 3.7 percent of GDP in 2017 to 5.8 percent of GDP by 2038, and then increase gradually thereafter to about 6.2 percent of GDP by 2092." [Also available: 2018 Expanded and Supplementary Tables and Figures (ZIP)] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Medicare Financial Outlook Worsens
"[T]he trustees projected lower wages for several years, which will mean lower payroll taxes, which help fund the program. The recent tax cut passed by Congress would also result in fewer Social Security taxes paid into the hospital trust fund, as some higher-income seniors pay taxes on their Social Security benefits. The aging population is also putting pressure on the program's finances." (Kaiser Health News)
Social Security Combined Trust Fund Reserves Depletion Year Remains 2034
"In the 2018 Annual Report to Congress, the Trustees announced: [1] The OASI Trust Fund is projected to become depleted in late 2034, as compared to last year's estimate of early 2035, with 77 percent of benefits payable at that time. [2] The DI Trust Fund will become depleted in 2032, extended from last year's estimate of 2028, with 96 percent of benefits still payable.... [3] The asset reserves of the combined OASDI Trust Funds increased by $44 billion in 2017 to a total of $2.89 trillion. [4] The total annual cost of the program is projected to exceed total annual income in 2018 for the first time since 1982, and remain higher throughout the 75-year projection period." (U.S. Social Security Administration [SSA])
Declines in Hospital-Acquired Conditions Save 8,000 Lives and $2.9 Billion in Costs
"National efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016 ... Examples of hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, pressure injuries, and surgical site infections, among others." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Facts About Medicare That All Employers Should Know
"[1] For most health plans, Medicare will take on the role of the 'Secondary Payer,' while your health plan will be the 'Primary Payer.' ... [2] For employers with less than 20 employees, Medicare will generally act as the Primary Payer for Medicare-entitled employees.... [3] [If] an employee's spouse receives coverage through your plan as a dependent, and the spouse retires but the employee continues to work, your plan will typically act as the Primary Payer for the retired spouse, and Medicare will be the Secondary Payer." (HR Daily Advisor)
Outdated Medicare Marketing Strategies Likely to Cost Health Plans Millions
"Health plans are likely foregoing millions in potential revenue by halting marketing efforts to potential Medicare enrollees if they don't opt in by their 65th birthday.... 48% of consumers intend to delay Medicare enrollment beyond the age of 65; 70% of those nearing Medicare age have performed at least one health activity online; 53% say they will shop for their Medicare plan online." (HealthLeaders Media)
Costs for Seniors Jump as Generic Drugs Move to Higher Formulary Tiers in Part D Plans
"Senior citizens with Medicare prescription drug plans ... are paying more for generic prescriptions even as the market price of these drugs stays flat ... because, over time, the generic drugs are being placed on higher formulary tiers where patients pay more out-of-pocket costs. The number of generic prescription drugs placed on the least-costly lowest tier fell 53% between 2011 and 2015. This shift resulted in a 93% increase in total patient cost sharing for these drugs, or a total of $6.2 billion." (American Journal of Managed Care)
HSAs and Medicare: Like Oil and Water
"Being enrolled in any part of Medicare, including the usually free Part A, leaves taxpayers ineligible for deposits into an HSA.... Many choose to defer their enrollment into Medicare so they can keep taking advantage of HSA tax benefits. And this can be done without penalty as long as the member is covered under a qualified HDHP plan as a result of their own (or their spouse's) active employment through an employer of 20 or more employees.... Most people don't know that when you sign up to collect Social Security retirement income, you're automatically enrolled in Medicare Part A." (Frenkel Benefits)
HSA + Medicare: Using an HSA to Pay for Medicare Premiums and More
"You can still use your HSA funds if you have Medicare coverage. You may withdraw funds from your HSA at any time, regardless of whether you are eligible to contribute to your HSA.... [Y]ou may not contribute to an HSA while enrolled in Medicare.... By choosing to postpone enrollment in Medicare, you are still eligible to make contributions to your HSA until the first day of enrollment." (Connect Your Care)
CMS Sends Clear Message to Plans: Stop Hiding Information from Patients
"[On May 17, CMS] sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called 'gag clauses' are unacceptable, as part of the Administration-wide 'American Patients First' initiative to lower prescription drug costs." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
CMS Releases 2019 Medicare Part D Benefit Parameters
"The standard benefit parameters will increase by approximately 1.5 to 2.5%, with the OOP threshold increasing by 2%. Plan sponsors that want to remain qualified for the employer retiree drug subsidy will have to determine if their 2019 prescription drug coverage is at least actuarially equivalent to the standard Medicare Part D coverage." (Conduent)
[Opinion] Urban Institute Proposes the 'Healthy America Program'
"[This] proposal builds on components of the Medicare program and the ACA Marketplaces.... The large new Medicare-style marketplace, featuring a public plan and private insurer options, would contain costs by fostering competition among many insurers, capping provider payment rates, and addressing prescription drug pricing. This proposal is less ambitious than a single-payer system ... but it would get close to universal coverage with much lower increases in federal spending and less disruption for people currently enrolled in employer coverage or Medicare." (Urban Institute)
HHS to Resurrect Medicare Part B Price Bidding Program
"HHS Secretary Alex Azar announced May 14 that the agency plans to propose a program to merge some Part B drugs with Part D, where their prices could be negotiated, a major goal of Trump's plan to lower drug prices.... Such a program has been used before with poor results." (FierceHealthcare)
The Lifetime Medical Spending of Retirees
"[At] age 70, households will on average incur $122,000 in medical spending, including Medicaid payments, over their remaining lives. At the top tail, 5 percent of households will incur more than $300,000, and 1 percent of households will incur over $600,000 in medical spending inclusive of Medicaid. The level and the dispersion of this spending diminish only slowly with age." (National Bureau of Economic Research [NBER]; purchase required for full document)
Employer-Sponsored Insurance Stable for Low-Income Workers in Medicaid Expansion States
"[The authors] assessed rates of employer health insurance offer, take-up, and coverage in June 2013 and March 2017 among workers. Overall, offer rates remained stable, and take-up and coverage rates increased. In Medicaid expansion states, the share of workers with family incomes at or below 138 percent of the federal poverty level who had employer-based coverage held steady, while uninsurance rates declined." (Urban Institute)
Proposal Would Allow Employers to Purchase Medicare for Employees
"[The Choose Medicare Act (S. 2708)] provides that public health plans (to be known as Medicare Part E) would be offered on all state and federal exchanges. Employers could choose to select Medicare Part E rather than private insurance to provide health care to their employees. The plans would cover essential health benefits and all items and services covered by Medicare." (Wolters Kluwer Law & Business)
CMS Proposed Regs Would Require Hospital Price Transparency
"[T]he proposed rule ... would require hospitals to post their pricing lists online, accessible to patients in a 'consumer-friendly' way ... CMS is also ... asking stakeholders to comment on ... what information stakeholders would find most useful, and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant data to more readily compare providers. CMS is considering making information on hospital noncompliance public." (Medliminal)
Recent Updates to Medicare and Social Security: Why They Matter (PDF)
"As a direct result of [recent] changes ... a 55-year-old couple each earning $70,000 in 2018 will face the following retirement challenges: [1] The cumulative cost of the delay in Means Testing indexing, combined with the lowering of brackets three through five, will increase their lifetime surcharges by almost $122,000 (over $272,000 in future value). [2] The elimination of 'File Restricted' and 'File and Suspend' claiming strategies will result in the loss of over $36,000 (nearly $78,000 in future value) in potential lifetime Social Security benefits.... If future COLAs are consistent with the latest Social Security Trustee projections (2.6%), the couple will require 123% of their Social Security income to meet their future health care expenses." (HealthView)
Is Your Employer Health Plan Coverage Creditable?
"Creditable drug coverage should 'meet or exceed' what Medicare's Part D plan minimums are for that current year. Puzzling, I know. Medicare does not regard discount prescription drug cards or low-cost generics programs as 'creditable coverage.' These types of plans cannot keep you from the Late Enrollment Penalty. BUT ... Medicare does consider receiving your prescription drugs from the VA as creditable coverage." (Houston Chronicle)
[Guidance Overview] CMS Proposes Changes in Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System
"While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers." [Also see a fact sheet and the CMS proposed rule.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Retirement and Health Plan Provisions in the Bipartisan Budget Act of 2018
"[1] A congressional committee is created to address the long-term solvency of multiemployer pension plans and the PBGC. [2] 401(k) plan participants will have expanded ability to take hardship distributions. [3]The coverage gap ('donut hole') in the Medicare Part D prescription drug program will close faster resulting in lower out-of-pocket costs for retirees. [4] There are additional increases in the amount that certain high-income Medicare beneficiaries will have to pay for their Part D and Part B premiums." (Segal Consulting)
How Fear of Catastrophic Health Care Expenses May Cause Retirees to Inefficiently Self-Insure (PDF)
"[M]edian cumulative out-of-pocket medical expenses for the long-lived elderly is quite modest at $27,000. At the same time, it is true that some long-lived elderly report very high cumulative out-of-pocket medical expenses: 10 percent of this older cohort say they racked up more than $172,000 in out-of-pocket medical expenses, and 5 percent report spending more than $269,000 in out-of-pocket medical expenses.... While most (61 percent) long-lived elderly do enter a nursing home, less than one-third (32.2 percent) incur out-of-pocket nursing home expenses." (Employee Benefit Research Institute [EBRI])
CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements
"For 69 of the 100 claims in our sample, telehealth services met requirements. However, for the remaining 31 claims, services did not meet requirements.... 24 claims were unallowable because the beneficiaries received services at nonrural originating sites, 7 claims were billed by ineligible institutional providers, 3 claims were for services provided to beneficiaries at unauthorized originating sites ... Medicare could have saved approximately $3.7 million during our audit period if practitioners had provided telehealth services in accordance with Medicare requirements." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])
GOP Lawmakers Expected to Draft Bill to Expand Telehealth Services Under Medicare
"A broad coalition of health care stakeholders who are lobbying for the measure says it could save the government a lot of money while improving care for many Medicare beneficiaries. The bill has yet to be completed." (Morning Consult)
No Breach of Fiduciary Duty for Health Plan TPA That Overpaid Claims for Participant Eligible for ESRD-Based Medicare
"A union's health trust fund sued its TPA, claiming that the TPA breached its fiduciary duties under ERISA and its contractual duties under an administrative services agreement (ASA) by continuing to pay benefits for a participant after he became eligible for Medicare based on end stage renal disease (ESRD).... The court dismissed the claims against the TPA, concluding that it was not the TPA's duty to track participants' Medicare eligibility or applicability of the MSP requirements.... [T]he ASA expressly made the employer responsible for investigating participants' Medicare eligibility status." [Birmingham Plumbers and Steamfitters Local Union No. 91 Health and Welfare Trust Fund v. Blue Cross Blue Shield of Alabama, No. 17-443 (N.D. Ala. Mar. 8, 2018)] (Thomson Reuters / EBIA)
Medicare Advantage Plans Cleared to Go Beyond Medical Coverage -- Even Groceries
"(CMS) expanded how it defines the 'primarily health-related' benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.... CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care." (Kaiser Health News)
CMS Sets 3.40 Percent Hike in 2019 Payments to Medicare Insurers
"[CMS] said it would increase by 3.40 percent on average 2019 payments to the health insurers that manage Medicare Advantage insurance plans ... a higher-than-expected rise reflecting a projection of higher medical cost growth. The rate, which affects how much insurers charge for monthly healthcare premiums, plan benefits and, ultimately, how much they profit, represents an increase over the 1.84 percent increase proposed by [CMS] in February." (Reuters)
CMS Lowers the Cost of Prescription Drugs for Medicare Beneficiaries
"[A]ctions that CMS is finalizing to lower the cost of prescription drugs include: [1] Allowing for certain low-cost generic drugs to be substituted onto plan formularies at any point during the year ... [2] Increasing competition among plans by removing the requirement that certain Part D plans have to 'meaningfully differ' from each other ... [3] Increasing competition among pharmacies by clarifying the 'any willing provider' requirement[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Thousands Mistakenly Enrolled During California's Medicaid Expansion, Feds Find
"HHS' inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were 'potentially' ineligible, auditors found. Auditors said nearly 90 percent of the $1.15 billion in questionable payments involved federal money, while the rest came from the state's Medicaid program[.]" (Kaiser Health News)
Medicare and COBRA Enrollment
"The interaction between Medicare and COBRA can be a minefield for employers and former employees alike. This article provides a brief overview of how these two bodies of law interact and some potential pitfalls." (HUB International)
[Opinion] Congressional Letter to CMS Requesting Changes to 2019 Advanced Notice and Call Letter (PDF)
"For CY 2019, CMS is proposing to fully phase-in a new payment methodology ... [which] is not set based on actual bids submitted by the Employer Group Waiver Plans (EGWPs), but is instead based off bids submitted by non-EGWP plans. This new payment methodology may reduce employers' ability to provide retiree benefits through a consolidated health plan encompassing both Medicare benefits and supplemental retiree offerings, thus reducing beneficiary choice.... [We] request that CMS reconsider the changes finalized by the previous Administration as part of the CY 2017 Final Notice and instead find a payment methodology that will best account for the difference in the proportion of beneficiaries who are enrolled in a Health Maintenance Organization (HMO) versus a Preferred Provider Organization (PPO)." (Energy and Commerce Committee, U.S. House of Representatives)
Bipartisan Budget Act Affects Retirement and Health Care Plans
"The act increases Medicare premiums for some and closes the Medicare Part D coverage gap a year ahead of schedule. Recipients of retirement plan distributions due to the California wildfires are now eligible for the same tax relief provided last year for distributions due to major hurricanes. The act repeals the Independent Payment Advisory Board, which was created under the ACA to curb the growth in Medicare spending." (Willis Towers Watson)
CMS Expands Reimbursement for Telehealth Services
"Beginning in CY 2018, CMS has both: [1] expanded the list of telehealth services that are reimbursed as 'Medicare services'; and [2] decreased the burdens for physicians in billing the government for telehealth services.... CMS's decision to add seven new categories of services is encouraging for those hoping to see increased reimbursement for telehealth services before entering the market." (Akerman)
Medicare Secondary Payer Compliance: Non-Group Health Plans (NGHPs)
"The most recent NGHP policy guidance covers several forms of liability insurance (including self-insurance), no-fault insurance, and workers compensation in several states of existence and decay, such as NGHPs that are in bankruptcy, those that are acquired by larger entities, those that are in the liquidation process, and those that are general self-insurance pools.... There is no blanket requirement that all NGHPs register with Medicare, but those that have reportable information must register at least a quarter before submitting a report." (Health Law Advisor, Epstein Becker Green)
[Guidance Overview] Medicare Secondary Payer Compliance for Group Health Plans
"Given recent enforcement trends, and the risk of raising damages for non-compliance from double to treble, including a minimum fine of $1000 per day per unreported beneficiary, [group health plans (GHPs)] may want to review and audit their compliance with MSP requirements.... GHPs with 20 or more employees report certain information to CMS to avoid payment conflicts (although smaller companies have certain limited reporting obligations)." (Health Law Advisor, Epstein Becker Green)
[Guidance Overview] March 1 Deadline for Calendar Year Health Plans to Complete CMS Disclosure
"Instructions related to the online filing discuss the types of information required, including an estimate of the total number of Part D eligible individuals, the number of prescription drug options and which options are creditable or noncreditable." (Lockton)
The Bipartisan Budget Act Boosts Medicare: Flexibility and Financing for Healthcare Plans and Providers
"[Changes made by the Act] include: [1] the addition of non-medical services ... and telehealth services to the range of MA-covered services that an MA plan can offer to its members; ... [2] disbanding the Independent Payment Advisory Board (IPAB), a board comprised of presidential appointees whose sole authority and responsibility was to cut Medicare costs and expenses; and [3] an increase in the discounts that pharmaceutical companies must give seniors enrolled in Medicare Part D drug plans by making the so-called 'doughnut hole' disappear in 2019." (Sheppard Mullin)
Budget, White Paper Provide Insight Into Administration's Strategy on Drug Pricing
"The bulk of the proposed reforms would act on the Medicare and Medicaid programs. For Medicare, the Trump administration's proposals are largely targeted at [1] assisting beneficiaries with high out-of-pocket costs and [2] realigning incentives to alter prescribing and reimbursement practices." (Health Affairs)
New Budget Bill Eliminates ACA's Independent Payment Advisory Board
"The bill does not include broader ACA market stabilization measures -- such as payments for cost-sharing reductions or reinsurance funds -- that have received bipartisan support.... [This article] focuses on the repeal of the [Independent Payment Advisory Board (IPAB)], cuts to the Prevention and Public Health Fund, and the delay of Medicaid cuts to disproportionate share hospitals." (Katie Keith, in Health Affairs)
How Do Prescription Drugs Affect the Use of Other Health Services?
"Medicare Part D, introduced in 2006, has increased spending on prescription drugs for the elderly, but its impact on other health spending is unclear. The analysis addresses this issue by examining the use of other health care before and after Part D was introduced. The results show that the impact of Part D varied by the type of service: It significantly increased spending on office visits, for purposes such as monitoring the effects of the drugs. But it may have decreased spending on hospital visits by reducing the need for more intensive care, such as surgery." (Center for Retirement Research at Boston College)
Medicare Beneficiaries' Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future
"In 2013, Medicare beneficiaries' average out-of-pocket health care spending was 41 percent of average per capita Social Security income; the share increased with age and was higher for women than men, especially among people ages 85 and over. Medicare beneficiaries' average out-of-pocket health care spending is projected to rise as a share of average per capita Social Security income, from 41 percent in 2013 to 50 percent in 2030." (Henry J. Kaiser Family Foundation)
Medicare Premium, Deductible and Coinsurance Numbers for 2018
"The standard Part B premium will remain at $134 for 2018.... The annual deductible for all Medicare Part B beneficiaries will be $183.00, the same as for 2017.... The Part A deductible and coinsurance will increase by 1.83 percent." (Segal Consulting)
Medicare Fails to Recover Hundreds of Millions of Dollars in Lab Overcharges
"As the nation's bill for drug and genetic tests has climbed to an estimated $8.5 billion a year, there's mounting suspicion among health insurers that some testing may do more to boost profit margins than help treat patients.... Yet, getting these firms to repay Medicare and private insurers remains a formidable challenge." (Kaiser Health News)
CMS Releases Medicare Part A and B Premium Values for 2018
"[CMS] has announced the 2018 Medicare Part A and B premium, deductible, and coinsurance amounts. There is a small increase in Part A amounts, and while the standard Part B premium will not increase in 2018, some Part B enrollees protected by a 'hold harmless' provision in 2017 will pay more. The Part B deductible will not increase for any beneficiaries." (Conduent)
CMS Updates Medicare Advantage Value-Based Insurance Design Model for 2019
"Beginning in 2019, the VBID model will expand to an additional fifteen new states for a total of 25 states, allow Chronic Condition Special Needs Plans to participate, and allow participants to propose their own systems or methods for identifying eligible enrollees. This change will afford participants with the opportunity to include Medicare beneficiaries with different chronic conditions than those previously established by CMS[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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)
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