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All News > Medicare

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Implementing the Drug Negotiation Provisions of the Inflation Reduction Act: Considerations for CMS
Health Affairs Forefront Link to more items from this source
[Opinion]
Sept. 30, 2022

"While other nations have decades of experience in drug price regulation, the IRA creates a new challenge for Medicare’s administrators. How it carries out this work will have important implications for stakeholders and is critical to determining whether this new authority can be sustained or, as some may hope, built upon to regulate additional drug prices."

Tags: Medicare  •  Prescription Drug Costs

Text of CMS Announcement: 2023 Medicare Parts A & B Premiums and Deductibles, 2023 Medicare Part D Income-Related Monthly Adjustment Amounts
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Sept. 27, 2022

"The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.... The decrease in the 2023 Part B premium aligns with the CMS recommendation in a May 2022 report that excess SMI reserves be passed along to people with Medicare Part B coverage."

Tags: Health Plan Costs  •  Medicare

October 14 Deadline: Medicare Part D Notice of Creditable (or Non-Creditable) Coverage
Fraser Trebilcock Link to more items from this source
[Guidance Overview]
Sept. 27, 2022

"With respect to group health plans including prescription coverage offered by an employer to any Medicare Part D eligible employees (whether or not retired) or to Medicare Part D Medicare-eligible spouses or dependents, the employer must provide those individuals with a Notice of Creditable or Non-Creditable Coverage to advise them whether the drug plan's total gross value is at least as valuable as the standard Part D coverage (i.e., creditable). Medicare Part D notices must be provided to Medicare-eligible individuals prior to October 15th of each year (i.e., by October 14th)."

Tags: Health Plan Administration  •  Medicare

Who Will Benefit from Prescription Drug Price Regulation Changes?
InsuranceNewsNet.com Link to more items from this source
Sept. 26, 2022

"Sponsors of employer/union group Medicare plans may see lower costs ... and supplementary benefits in group Medicare plans will count toward the new $2,000 patient Part D out-of-pocket maximum, making it more attractive for employers to supplement benefits. Some employers fear that drug costs will shift from Medicare to employers. But the high visibility of the lower Medicare prices could create additional leverage for commercial payers to negotiate lower net prices."

Tags: Medicare  •  Prescription Drug Costs

Why Single Seniors Pay More for Health Care
MassMutual Link to more items from this source
Sept. 26, 2022

"Out-of-pocket spending for recurring health care expenses, it found, averaged roughly $2,500 per person for both single and couple households, and generally did not change with age. The average total non-recurring expense for singles age 65 and older, however, was $7,122, compared with $3,161 for couples. The differences are greatest for nursing home costs and home health care, which suggests couples may benefit from having their spouse or partner available to deliver care."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare

HRPA Letter to Congress Expressing Concerns with the Restore Protections for Dialysis Patients Act (PDF)
HR Policy Association [HRPA] Link to more items from this source
[Opinion]
Sept. 23, 2022

"The legislation [S 4750] is unnecessary because a variety of federal requirements already protect ESRD patients from losing their employer-provided health care benefits.... The legislation also creates a completely unworkable parity requirement for patients with end stage renal disease (ESRD).... The bill fails to account for different medical practice standards, treatment needs, and value-based benefit designs for widely varying chronic medical conditions and incorrectly assumes or implies that, from a medical perspective, all chronic conditions are and should be treated exactly the same."

Tags: Health Plan Policy  •  Medicare

Retirement Planning: How Much Money Will You Need to Cover Your Healthcare Expenses?
Milliman Link to more items from this source
Sept. 23, 2022

"[C]osts under the two most common pathways taken by Medicare-eligible retirees: ... [1] Original Medicare plus Medigap (Plan G) plus Part D (standard benefit): A healthy 65-year-old male retiring in 2022 is projected to spend approximately $264,000 on healthcare expenses during his retirement.... [2] Medicare Advantage plus Part D: A healthy 65-year-old male retiring in 2022 is projected to spend approximately $137,000 on healthcare expenses during his retirement."

Tags: Health Plan Costs  •  Medicare  •  Misc. Distribution Issues  •  Retirement Plan Design

Deadline for Medicare Part D Creditable/Non-Creditable Coverage Notices Is October 14
Buck Link to more items from this source
[Guidance Overview]
Sept. 20, 2022

"Plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-enrolled individuals before each year’s Medicare Part D annual enrollment period -- this year, by October 14. The notice obligation is not limited to retirees and their dependents but also includes Medicare-enrolled active employees and their dependents and Medicare-enrolled COBRA participants and their dependents."

Tags: Health Plan Administration  •  Medicare

Medicare Telehealth Trends
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
Sept. 16, 2022

"The Medicare Telehealth Trends dataset provides information about people with Medicare who used telehealth services between January 1, 2020 and March 31, 2022.... The data include Medicare Part B Fee-for-Service Claims for services. All data are preliminary."

Tags: Medicare  •  Teleheath

HHS-OIG Flags Certain Extreme Outlier Telehealth Providers as Potentially Engaging in Fraudulent Billing During the Pandemic
Sidley Austin LLP Link to more items from this source
Sept. 16, 2022

"HHS-OIG identified 1,714 providers who had 'concerning billing on at least one of seven measures… that may indicate fraud, waste, or abuse of telehealth services' and referred these providers to CMS for further investigation. While this could be read to suggest that billing data for the vast majority of providers has a clean bill of health, the report indicates that HHS-OIG identified only the most significant outliers on each metric."

Tags: Medicare  •  Teleheath

Inflation Reduction Act May Impact Employer Health Plans
EPIC Link to more items from this source
Sept. 15, 2022

"While there is no direct impact on employer-sponsored health plans, caps on Medicare Part D out-of-pocket limits and other cost reductions could affect prescription drug coverage creditable status. Employers must provide notice of a health plan's creditable coverage status at different times, and at least annually before October 15."

Tags: Medicare  •  Prescription Drug Costs

Hospitals Divert Primary Care Patients to Health Center 'Look-Alikes' to Boost Finances
Kaiser Health News Link to more items from this source
Sept. 14, 2022

"A growing number of hospitals are outsourcing often-unprofitable outpatient services for their poorest patients by setting up independent, nonprofit organizations to provide primary care. Medicare and Medicaid pay these clinics ... significantly more than they would if the sites were owned by hospitals."

Tags: Health Plan Costs  •  Medicare

Walmart, UnitedHealth to Offer Preventive Healthcare Program for Seniors
Reuters; free registration may be required Link to more items from this source
Sept. 8, 2022

"The 10-year partnership represents Walmart's latest push into healthcare and could help the retail giant better compete with CVS Health and Walgreens Boots Alliance. Walmart's clinics could get a boost of new customers from UnitedHealth's Medicare Advantage members, while UnitedHealth gains access to the largest U.S. retailer's footprint and a venue to enroll more people[.]"

Tags: Health Plan Design  •  Medicare

Benefits-Related Provisions of the Inflation Reduction Act of 2022
Groom Law Group Link to more items from this source
[Guidance Overview]
Aug. 31, 2022

"[1] Extension of ACA subsidies ... [2] Medicare prescription drug pricing negotiations ... [3] Manufacturer rebates under Medicare ... [4] HSA safe harbor for insulin."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare

Inflation Reduction Act Contains 'Unprecedented' Health Care Provisions
InsuranceNewsNet.com Link to more items from this source
Aug. 15, 2022

"The bill makes major changes to Medicare as well as extends the enhanced tax credits that enable Americans to buy health insurance through the [ACA] exchanges. Those enhanced tax credits were due to expire at the end of this year, leaving an estimated 3 million people without coverage."

Tags: Health Plan Costs  •  Medicare

The Inflation Reduction Act’s Health Provisions
Segal Link to more items from this source
Aug. 12, 2022

"An important part of the law will impact the ACA Exchanges and the Medicare program, including the Medicare Part D program and Employer Group Waiver Plans (EGWPs) used by employers and other plan sponsors to provide prescription drug coverage to retirees.... While the bill caps the amount that individuals covered by Medicare will pay for insulin, it does not adopt requirements that affect group health plan cost-sharing for insulin."

Tags: Medicare  •  Prescription Drug Costs

Inflation Reduction Act Includes Major Medicare Drug Price Reforms But Leaves Out Employer Plans
Mercer Link to more items from this source
Aug. 12, 2022

"Because all the bill's drug pricing reforms apply only to Medicare, however, the legislation is raising worries that it could the result in significant cost-shifting to commercial market plans, meaning higher drug prices and costs for the millions of Americans and their families who get their health coverage through employer-sponsored plans.... The bill also includes a provision that codifies IRS/Treasury rules that allow Health Savings Account (HSA)-qualifying high-deductible health plans to cover insulin on a pre-deductible basis."

Tags: HSAs  •  Medicare  •  Prescription Drug Costs

Understanding the Inflation Reduction Act's Drug Pricing Package
Health Affairs Forefront Link to more items from this source
Aug. 11, 2022

"The IRA's drug pricing reforms include Medicare drug price negotiation, Medicare inflationary rebates, and Medicare Part D redesign ... [This article provides] a broad overview of the three main pillars of the IRA's drug pricing reforms -- considering their differences from prior legislative proposals, as well as clarifying what other reforms are not included in the package."

Tags: Medicare  •  Prescription Drug Costs

Why the Inflation Reduction Act Will Reduce Medicare Drug Costs, Not Cut Benefits
Center on Budget and Policy Priorities Link to more items from this source
[Opinion]
Aug. 11, 2022

"The Inflation Reduction Act ... will reduce the cost of prescription drugs that are covered by Medicare ... In total, these changes will save the government about $250 billion over ten years and will also lower premiums and cost sharing for Medicare beneficiaries."

Tags: Medicare  •  Prescription Drug Costs

A Medicare Surcharge That Might Surprise You If You’re Not Careful: IRMAA
Kiplinger Link to more items from this source
Aug. 3, 2022

"IRMAA is determined based on your income from two years earlier. In other words, for your 2022 Medicare premiums, your 2020 income tax return is used. The amount is recalculated annually.... Here are some reasons you might encounter it: Excessive Roth conversions in one year ... The death of a spouse ... Required minimum distributions (RMDs)."

Tags: Medicare

How Much Does Health Spending Eat Away at Retirement Income?
Center for Retirement Research at Boston College Link to more items from this source
Aug. 2, 2022

"Even with Medicare coverage and ignoring long term care, retirees face sizable out-of-pocket costs for premiums, copays, and uncovered services.... After subtracting these costs, the typical retiree has only 75 percent of Social Security and 88 percent of total income left."

Tags: Health Plan Costs  •  Medicare  •  Social Security

Supreme Court: Treating All Dialysis Providers as Out-of-Network Does Not Violate Medicare
HUB International Link to more items from this source
July 19, 2022

"Self-funded plans recently won a significant victory at the Supreme Court ... [when the Court] ruled that a plan that treats all outpatient dialysis providers as out of network providers and fixes a consistent reimbursement rate for outpatient dialysis does not violate the Medicare Secondary Payer Rules (MSPR). This gives plan sponsors additional flexibility in dealing with outpatient dialysis expenses." [Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]

Tags: Health Plan Design  •  Medicare

Supreme Court Opens Door to Limiting Reimbursement Rates for Outpatient Dialysis Treatment
Miller Johnson Link to more items from this source
June 29, 2022

"[G]roup health plans may explore excluding outpatient dialysis as an in-network benefit or, at least, changing the reimbursement rate for out-of-network providers of outpatient dialysis services. This appears to be a permissible practice if the reimbursement rate is uniform and applies to all participants, regardless of an ESRD diagnosis. This may, however, only be possible for self-funded group health plans." [Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare

Supreme Court Reverses Sixth Circuit on Medicare Secondary Payer Act Anti-Discrimination Rules
Squire Patton Boggs Link to more items from this source
June 27, 2022

"[The Supreme Court] rejected the Sixth Circuit majority's 'disparate-impact' theory because the text of the Act's anti-discrimination provision 'does not ask about 'the effects of non-differentiating plan terms that treat all individuals equally.' ... And the text of the plan, according to the opinion, did not 'differentiate in the benefits provided to individuals with and without end-stage renal disease,' because it provided the same benefits, 'including the same outpatient dialysis benefits, to individuals with and without end-stage renal disease.' " [Marietta Memorial Hospital Employee Health Benefit Plan v. Da Vita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]

Tags: Health Plan Design  •  Medicare

Supreme Court Upholds Health Plan's Limitations on Dialysis Coverage
Graydon Link to more items from this source
June 24, 2022

"This ruling signifies a win for group health plans. Unless Congress amends the MSPA, courts considering similar disputes will first look to whether a health plan provision offers different coverage to individuals who have ESRD compared to those who do not. If the provision provides the same coverage regardless of an ESRD diagnosis, the differentiation inquiry should end there." [American Hospital Association v. Becerra, No. 20-1114 (S. Ct. Jun. 15, 2022)]

Tags: Health Plan Design  •  Medicare

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