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Medicare Blog | Medicare News | Medicare Information

Book of the Month: The Energy Bus

Posted by www.psmbrokerage.com Admin on Fri, May 29, 2020 @ 04:00 PM

Tags: book of the month

Five Largest Payers See Nearly Three-Quarters of All OEP Membership Gains

Posted by www.psmbrokerage.com Admin on Fri, May 29, 2020 @ 03:28 PM

Tags: Medicare Advantage

Seniors Will Pay Less For 2020 Medicare Premiums, Study Finds

Posted by www.psmbrokerage.com Admin on Fri, May 29, 2020 @ 02:56 PM

Tags: Medicare, Retirement Planning

Medicare enrollment complicated by the pandemic

Posted by www.psmbrokerage.com Admin on Fri, May 29, 2020 @ 02:31 PM

Tags: Medicare, COVID-19

Continued Year-Over-Year Growth for Medicare Supplement Plans

Posted by www.psmbrokerage.com Admin on Fri, May 29, 2020 @ 09:46 AM

Tags: Medicare Supplement

New Poll Highlights Impact of Coronavirus on Personal Health, Economic, and Food Security

Posted by www.psmbrokerage.com Admin on Thu, May 28, 2020 @ 04:02 PM

Tags: COVID-19

Medicare Advantage members are taking to telehealth

Posted by www.psmbrokerage.com Admin on Thu, May 28, 2020 @ 03:06 PM

Tags: Medicare Advantage, Telehealth

President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors

Posted by www.psmbrokerage.com Admin on Thu, May 28, 2020 @ 01:26 PM

Tags: Medicare Part D, CMS, Prescription Drugs

Cigna Supplemental: New Medicare Supplement release in Indiana

Posted by www.psmbrokerage.com Admin on Wed, May 27, 2020 @ 03:47 PM

Tags: Indiana

2021 Medicare Advantage Expansion Details

Posted by www.psmbrokerage.com Admin on Wed, May 27, 2020 @ 03:17 PM

Tags: Medicare Advantage, 2021 aep

Walmart Retail Program for Independent Agents

Posted by www.psmbrokerage.com Admin on Wed, May 27, 2020 @ 03:11 PM

Tags: Retail Program, 2021 aep

Important information about the 2021 AHIP Medicare + FWA training season

Posted by www.psmbrokerage.com Admin on Wed, May 27, 2020 @ 09:29 AM

Tags: AHIP, 2021 certification

Life Carriers Cut Age Groups From Coverage

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 04:15 PM

Tags: Life Insurance, COVID-19

Why Sell Humana Achieve Medicare Supplement Plans?

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 03:34 PM

Tags: humana medicare supplement, Humana Achieve

Introducing National Care Dental Plans

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 02:40 PM

Tags: dental plans, national care dental

CMS finalizes telehealth and ESRD changes for Medicare Advantage

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 02:19 PM


CMS finalizes telehealth and ESRD changes for Medicare Advantage

Changes Sign


CMS today (Friday) finalized (earlier news release) several changes to Medicare Advantage and Part D but said more updates are coming.

The final rule will make it easier for Medicare Advantage plans to meet network adequacy standards. Advantage plans can now contract with telehealth providers for specialties like cardiology and receive a 10% boost to their percentage of beneficiaries that live within the time and distance requirements, according to a CMS fact sheet.

"This flexibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas," CMS said in a statement.

The agency is also reducing the percentage of beneficiaries required to meet those standards from 90% to 85%, and easing network adequacy standards for outpatient dialysis. Advantage plans can also get a credit to offset the "adverse effects" of state Certificate of Need Laws, according to CMS.

Beginning in 2021, Medicare beneficiaries with end-stage renal disease will be able to enroll in Medicare Advantage plans, as mandated by the Cures Act. Until now, they couldn't get dialysis treatment under Medicare Advantage unless they were diagnosed with the disease after enrollment.

"This will give beneficiaries with ESRD access to more affordable Medicare coverage options that may include extra benefits such as health and wellness programs, transportation, or home-delivered meals that are not available in Medicare Fee-For-Service," according to CMS.

The final rule also boosts the impact of patient experience and access under the Medicare Advantage and Part D star ratings system. It also increases the predictability and stability of the ratings by lowering the impact of outliers, the agency said. By removing outliers from the ratings calculations, CMS estimates the federal government will save $3.65 billion over 10 years.

The agency said that the final rule "focuses on more immediate regulatory actions," which includes implementing changes required by the Bipartisan Budget Act of 2018 and the 21st Century Cures Act. Both laws required the changes to be made by June 1, 2020.

"CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year," the agency said in a statement.

Story developing...

https://www.modernhealthcare.com/medicare/cms-finalizes-telehealth-and-esrd-changes-medicare-advantage

 

Tags: Medicare Advantage, ESRD

The coronavirus economy could make a Medicare buy-in more popular

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 01:52 PM

Tags: Medicare, COVID-19

Humana: 2021 Certification & Recertification Details

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 11:56 AM

Tags: Humana, 2021 certification

Changes to Medicare Advantage and Part D will Provide Better Coverage and Increase Access for Medicare Beneficiaries

Posted by www.psmbrokerage.com Admin on Fri, May 22, 2020 @ 11:17 AM


CMS: Changes to MA and Part D will Provide Better Coverage and Increase Access for Medicare Beneficiaries

Final Rule continues to strengthen Medicare Advantage and drug plans

strong blog pic


The Centers for Medicare & Medicaid Services today finalized requirements that will increase access to telehealth for seniors in Medicare Advantage (MA) plans, expand the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases, provide support for more MA options for beneficiaries in rural communities, and expand access to MA for patients with End Stage Renal Disease (ESRD).


Together, the changes advance President Trump’s Executive Orders on Protecting and Improving Medicare for Our Nation’s Seniors and Advancing American Kidney Health as well as several of the CMS strategic initiatives.

Due to the upcoming June 1, 2020, MA and Part D bid deadlines for the 2021 plan year, CMS is finalizing a subset of the proposed policies before the MA and Part D plans’ bids are due. CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year.

We understand that the entire healthcare sector is focused on caring for patients and providing coverage related to coronavirus disease 2019 (COVID-19), and we believe this approach provides plans with adequate time and information to design the best coverage for Medicare beneficiaries.

“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

Building on actions that the Trump Administration has taken to expand access to telehealth so beneficiaries can get care at home instead of traveling to a healthcare facility, today’s rule encourages MA plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas.

CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas (such as Dermatology, Psychiatry, Cardiology, Ophthalmology, Nephrology, Primary Care, Gynecology, Endocrinology, and Infectious Diseases) towards meeting CMS network adequacy standards. This flexibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas.

Today’s rule gives beneficiaries with ESRD more coverage choices in the Medicare program. Previously, beneficiaries with ESRD were only allowed to enroll in MA plans in limited circumstances.

The rule implements the changes made by the 21st Century Cures Act to give all beneficiaries with ESRD the option to enroll in an MA plan starting in 2021. This will give beneficiaries with ESRD access to more affordable Medicare coverage options that may include extra benefits such as health and wellness programs, transportation, or home-delivered meals that are not available in Medicare Fee-For-Service.

CMS is also finalizing proposals to enhance the MA and Part D Star Ratings system to further increase the impact that patient experience and access measures have on a plan’s overall Star Rating.

The Star Ratings system helps people with Medicare, their families, and their caregivers compare the quality of health and drug plans being offered. One of the best indicators of a plan’s quality is how its enrollees feel about their coverage experience.

This decision reflects CMS’s commitment to put patients first and improves incentives for plans to focus on what patients value and feel is important.

Additionally, CMS adopted a series of changes in the March 31, 2020, Interim Final Rule with Comment Period (CMS-1744-IFC) for the 2021 and 2022 Star Ratings to accommodate challenges arising from the COVID-19 public health emergency.

For a fact sheet on the Contract Year 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1), please visit: https://www.cms.gov/newsroom/fact-sheets/contract-year-2021-medicare-advantage-and-part-d-final-rule-cms-4190-f1-fact-sheet

The final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2020/06/02/2020-11342/medicare-program-contract-year-2021-policy-and-technical-changes-to-the-medicare-advantage-program

 

Tags: Medicare Advantage, MAPD, Telehealth

Medicare Advantage Enrolling More Low-Income and Medically Complex Beneficiaries

Posted by www.psmbrokerage.com Admin on Thu, May 21, 2020 @ 04:13 PM


Medicare Advantage Enrolling More Low-Income and Medically Complex Beneficiaries

Complex People Parts

Recent Trends in Beneficiary Clinical Characteristics, Health Care Utilization, and Spending

Toplines

  • From 2012 to 2015, there were major changes in the characteristics of Americans in Medicare Advantage plans, including more beneficiaries under 65 with disabilities, racial and ethnic minorities, and people with low incomes
  • The proportion of Medicare Advantage beneficiaries enrolled in a Special Needs Plan more than doubled from 2012 to 2015, and an increasing number of enrollees had social risk factors


Abstract

Issue: Enrollment in Medicare Advantage (MA) has grown significantly over the past two decades, with one of three Medicare beneficiaries now covered by these private plans. Yet we know little about their characteristics or experiences.

Goal: To analyze MA enrollees’ demographic, socioeconomic, and clinical characteristics as well as their health care utilization, spending, and quality of care.

Methods: Retrospective observational cohort analyses of Medicare encounter data for more than 2 million MA beneficiaries in 2012 and 1.8 million in 2015.

Key Findings: Between 2012 and 2015, the MA population grew younger and included greater proportions of racial and ethnic minorities. There were also more low-income beneficiaries, more living in poor neighborhoods, and more living in neighborhoods where few residents have college degrees. While chronic conditions had not become more prevalent by 2015, a greater proportion of beneficiaries had complex medical needs. Hospitalization rates were stable, but lengths of hospital stays increased as did use of observation stays and emergency department visits. Spending was 13 percent higher in 2015, largely because of spending on prescription drugs. Performance on several measures of health care quality improved, but medication adherence declined slightly.

Conclusions: MA plans will need to develop targeted interventions to address beneficiaries’ social risks, avoid medical complications, and increase medication adherence. Plans also need to reduce spending on postacute care, for example, by expanding use of services provided in beneficiaries’ homes.


Introduction

Enrollment in Medicare Advantage (MA) plans has grown significantly in the last two decades, from 4.6 million in 2003 to 18.5 million in 2017, representing 33 percent of the Medicare population.1 Over the same period, government payments to these private plans increased to more than $200 billion per year.2 Despite the increasing role of MA, there is little known about the composition, health care utilization, and spending patterns of enrollees.3 For example, although the Centers for Medicare and Medicaid Services (CMS) publishes data on the burden of chronic conditions among beneficiaries enrolled in traditional fee-for-service Medicare, the reports exclude the MA population because “claims data are not available for these beneficiaries.”

MA plans consist primarily of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Given how the plans are paid — monthly capitated payments for each member — they have incentives to avoid unnecessary utilization, coordinate care, and promote better health. They also have flexibility to provide benefits such as hearing, dental, vision, and care management services that are not offered under traditional Medicare. Plans that achieve designated levels of performance and enrollee satisfaction also earn bonus payments, which they may use to provide additional benefits, such as those related to disease prevention. Starting in 2019 and 2020 under the CHRONIC (Creating High-Quality Results and Outcomes Necessary to Improve Chronic) Care Act, Medicare Advantage plans have the option to offer nonmedical benefits like meal delivery, home modifications, help with daily activities, and other services that may promote health and functioning and help avoid medical complications.5

Our analysis is based on de-identified, nationally representative data drawn from Medicare Advantage members’ medical and pharmacy claims from more than 120 plans. It is the first comprehensive analysis of changes in the MA population between 2012 and 2015, including changes in demographic and socioeconomic characteristics, prevalence of chronic conditions, health care utilization, spending patterns, and performance on selected quality measures.


Findings

DEMOGRAPHIC AND PLAN CHARACTERISTICS

The study populations included 2.0 million MA beneficiaries in 2012 and 1.8 million beneficiaries in 2015. In 2015, MA beneficiaries on average were younger than in 2012 (Exhibit 1). The proportion of enrollees under age 65 years rose, indicating more people had qualified for Medicare because of disability. There also were more low-income beneficiaries. The proportion of MA beneficiaries enrolled in both Medicare and Medicaid — sometimes referred to as dual eligibles — increased by about 39 percent. The proportion of MA beneficiaries enrolled in a Special Needs Plan (SNP) for dually eligible beneficiaries more than doubled from 2012 to 2015. Such plans offer integrated benefits, but not all dually eligible MA beneficiaries are enrolled in them.

While most MA enrollees identified as white, the percentage identifying as racial or ethnic minorities increased by nearly 22 percent from 2012 to 2015. In both years, most MA enrollees lived in urban or suburban areas. The percentage of members enrolled in an HMO increased nearly 16 percent from 2012 to 2015.


Medicare Advantage Beneficiary Demographic and Plan Characteristics, 2012 and 2015

beneficiary characteristics chart


Social Risks

There is increasing evidence that people’s life circumstances, including their income and living conditions, affect their health and thus their health care utilization, outcomes, and spending.6 A growing number of MA beneficiaries have social risks that if unaddressed could lead them to become high-need, high-cost patients. This study used a unique granular source of social risk data aggregated at the nine-digit ZIP code level representing 30 million neighborhoods with an average of five households. From 2012 to 2015, the number of beneficiaries with median incomes below $30,000 increased 35 percent (Exhibit 2). The proportion of those living in a neighborhood where 20 percent or more of households lived below the federal poverty level increased by 29 percent, while the proportion in a neighborhood where less than 20 percent had a bachelor’s degree increased by 20 percent.

Medicare Advantage Beneficiary Socioeconomic Characteristics, 2012 and 2015

Social Risks Chart


Chronic Conditions

The average number of chronic conditions among MA beneficiaries increased slightly between 2012 and 2015, but there was a 12 percent increase in the number of beneficiaries with eight or more conditions (Exhibit 3). We also used the Charlson Comorbidity Index (CCI) to evaluate the severity of illness in the MA population.7 The average CCI score was higher in 2015 than in 2012 because of an increase in beneficiaries with a score of four or higher, indicating a larger number of beneficiaries with a high number of comorbidities.

Medicare Advantage Beneficiary Clinical Characteristics, 2012 and 2015

Chronic Conditions Chart

The prevalence and rank of chronic conditions was similar in 2012 and 2015. The five most common chronic conditions in both years were hypertension (diagnosed in 70% of beneficiaries in 2015), hyperlipidemia (64%), rheumatoid arthritis (34%), eye disease (33%), and diabetes (33%) (Exhibit 3; see Appendix A for complete list of top chronic conditions).

We applied algorithms developed in a previous analysis of the Medicare fee-for-service population to categorize patients into clinical groupings, or segments, using 29 chronic conditions.8 The clinical segments are designed to help health care providers and payers better target interventions and control costs, especially among high-need beneficiaries. These segments (defined in “How We Conducted This Study”) are:

  • disabled under age 65
  • frail elderly
  • major complex chronic
  • minor complex chronic
  • simple chronic
  • relatively healthy.

Results indicate that the MA population was distributed similarly across the segments in 2012 and 2015, with some notable exceptions (Exhibit 4). While the largest proportion of MA beneficiaries fell into the minor complex chronic segment in both 2012 and 2015, there were declines in the minor complex chronic, simple chronic, and relatively healthy segments and increases in the disabled under age 65 and frail elderly groups. The frail elderly segment indicates the presence of two or more frailty indicators, such as difficulty in walking, falls, and muscle weakness.

Medicare Advantage Beneficiaries by Clinical Segment, 2012 and 2015

Clinical Segment


Health Care Utilization and Spending

Rates of hospitalizations, outpatient visits, prescription drug fills, and the number of unique medications per member were stable from 2012 to 2015, but there was a significant increase in observation visits (43% higher) and emergency department visits (23% higher) (Exhibit 5). (Observation visits last no more than one night and give clinicians time to decide whether patients should be admitted to the hospital.) The average length of hospital stays also increased by 22 percent, indicating those who were admitted to the hospital were sicker on average in 2015 than in 2012.

Medicare Advantage Beneficiary Utilization and Spending, 2012 and 2015

Utilization and Spending Clip

Average total spending per member per year was 13 percent higher in 2015 than in 2012 ($11,116 vs. $9,799). This was largely because of substantially increased spending on prescription drugs (38% increase). Spending on hospital stays also increased by 25 percent, consistent with the longer lengths of stay, and spending on skilled nursing increased by 20 percent, which is consistent with the increase in the number of frail elderly beneficiaries.

We defined high-cost beneficiaries as those in the top 10 percent of total annual spending per beneficiary. Spending for these high-cost beneficiaries was similar in 2012 and 2015 (Exhibit 6). The largest increases were in prescription drug costs (79% higher) and inpatient costs (21.4% higher); inpatient costs were the highest category of spending in 2015. Spending on physician services and tests declined by 10.3 percent among high-cost beneficiaries, but it remained the second-highest category in 2015.

High-Cost Beneficiary Spending by Category, 2012 and 2015

High Cost Beneficiary Spending


Implications

About a third of all Medicare beneficiaries are enrolled in MA plans, but we know much less about their experiences than those of traditional Medicare enrollees. To our knowledge, this is the first study to profile and segment the MA population and evaluate recent trends in their demographic, socioeconomic, and clinical characteristics, as well as their health care utilization, spending, and quality.

We found major changes in the MA population from 2012 to 2015. Beneficiaries were younger on average because more people under age 65 qualified for Medicare due to disability. There were also more racial/ethnic minorities and more people with low incomes enrolling in MA. The proportion of MA beneficiaries enrolled in a Special Needs Plan for dually eligible beneficiaries more than doubled from 2012 to 2015. And more beneficiaries had social risks that could eventually make them high-need, high-cost patients. Further investigation is needed to evaluate whether these changes are driven by changes among Medicare beneficiaries generally, changes among those who select an MA plan, or by entry and exit of MA plans available in the market.

While the prevalence of chronic conditions among MA beneficiaries was relatively stable from 2012 to 2015, beneficiaries became more medically complex. More beneficiaries had multiple comorbid conditions, indicators of frailty (i.e., had difficulty walking, muscle loss, senility, or functional problems), or enrolled in Medicare because of disability.

Hospitalization rates, outpatient visits, and medication use were stable from 2012 to 2015, but there was a significant increase in observation stays and emergency department visits. The average length of stay also increased, indicating that on average those who were admitted to the hospital were sicker.

Overall spending was 13 percent higher in 2015, largely because of increased spending on prescription drugs. Spending on hospital stays also increased by 25 percent, consistent with the longer lengths of stay, and spending on skilled nursing increased by 20 percent, which is consistent with the increase in frail elderly beneficiaries. Spending for high-cost beneficiaries showed a similar pattern from 2012 to 2015, with the largest increases in prescription drug costs and inpatient costs. Spending on physician services and tests declined by 10.3 percent among high-cost beneficiaries.

MA beneficiaries had lower rates of potentially avoidable hospitalizations and hospital readmissions in 2015 than in 2012. There also was a significant decline in the use of high-risk medications, which may be linked to lower rates of hospitalizations. There was a slight increase in the breast cancer screening rate, but adherence to medications to treat cholesterol, diabetes, and hypertension declined slightly.

Our findings suggest that MA plans will need to develop targeted interventions to address social and medical risks among beneficiaries who, overall, have become poorer, frailer, and more medically complex in recent years. For example, plans should take steps to reduce complications in high-risk patients and increase adherence to prescribed medications. Several approaches for managing patients with multiple chronic conditions and/or unmet social needs have been shown to improve health outcomes and reduce the costs of care.9 MA plans also need to consider more efficient options and settings for post acute care for an increasingly frail population by expanding use of services in beneficiaries’ homes and engaging in robust management of transitions among care settings. And they may want to exercise new options under the CHRONIC Care Act to offer supplemental services to vulnerable beneficiaries.

Further research analyzing health care utilization, spending, and quality among different groups of MA enrollees would provide additional insight into the characteristics of the most high-need patients and enable plans to create targeted strategies to serve them.

Read The Full Brief Here: https://www.commonwealthfund.org/sites/default/files/2020-05/Teigland_Medicare_Advantage_beneficiary_trends_ib.pdf

 

Tags: Medicare Advantage, DSNP, Low Income Subsidy

Updated Guidance for Medicare Advantage Organizations Related to Covid-19

Posted by www.psmbrokerage.com Admin on Wed, May 20, 2020 @ 09:50 AM


Updated Guidance for Medicare Advantage Organizations Related to Covid-19


Q&A

The purpose of this document is to respond to questions related to the following HPMS Memos:

HPMS Memo titled: “Information Related to Coronavirus Disease 2019 - COVID-19” issued April 21, 2020 (revision of March 10, 2020 HPMS Memo).

HPMS Memo titled: “Updated Guidance for Medicare Advantage Organizations” issued April 24, 2020 to update information related to its previously issued April 21st guidance, “Information Related to Coronavirus Disease 2019 - COVID-19.”

1. Q. Are there time restrictions for the permissive actions related to additional benefits e.g., through the emergency period, through the rest of the calendar year, for a plan-defined period of time, or some other pre-determined time period)?

A. As indicated in the April 21, 2020 HPMS Memo, COVID-19 permissive actions may provided during a federal or state public health emergency.

2. Q. If a plan provides a Part C over the counter (OTC) supplemental benefit that was in the approved CY 2020 bid, can we increase the benefit allowance as a benefit enhancement?

A. Yes, this is within the scope of the April 21, 2020 HPMS Memo during a public health emergency (including CY 2021, if applicable). We note that permissive actions may be implemented more than one time (e.g., increasing the benefit allowance during the course of the contract year).

 

3. Q. If an approved CY 2020 bid does not include an existing Part C OTC supplemental benefit, can we add it as a benefit enhancement?

A.  Yes, this is within the scope of the April 21, 2020 HPMS Memo during a public health emergency (including CY 2021, if applicable). We note that permissive actions may be implemented more than one time (e.g., increasing the benefit allowance during the course of the contract year).


4. Q. Can a plan add a new benefit facilitated through a debit card that would all enrollees to use a dollar amount for specific primarily health related services (e.g., copays, OTC drugs, eyeglasses)? For non-primarily health related services (e.g., food and produce, non-medical transportation)?

A. Yes, for primarily health related items and services, plans may offer a group of supplemental benefits together with a single maximum plan benefit amount or allow the enrollee to pick one or more benefits from a list of supplemental benefits. A supplemental benefit must be provided uniformly to all plan enrollees or tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly based on chronic condition or health status (e.g., COVID-19 related diagnoses, quarantine, or stay at home order).
   
Non-primarily health related items and services may be provided as special supplemental benefits for the chronically ill (SSBCI), but to only enrollees who meet the definition of “chronically ill enrollee” in the statute (and implementing regulations once adopted). SSBCI may only be offered to the chronically ill enrollee if the benefit has a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee.

Therefore, a debit card reimbursement mechanism that would facilitate coverage or payment of both the primarily health related items and the non-primarily health-related items can only be offered and provided to chronically ill enrollees, while a debit card reimbursement mechanism that would facilitate coverage or payment of only the primarily health related items can be offered and provided to enrollees uniformly.

The April 21, 2020 HPMS Memo would permit an MA organization to add a mid-year benefit enhancement that includes coverage of these benefits as described here using the debit card reimbursement mechanism. Refer to the April 21, 2020 HPMS Memo for more details about the timeframe for this flexibility.

 

5. Q. Can a balance on a plan debit card be carried into CY 2021 as part of the COVID- 19 permissive actions?

A. Benefit enhancements (e.g., debit card balances) cannot extend beyond a contract year as part of the COVID-19 permissive actions.

 

6.  Q. Can we provide a smartphone/tablet or a cellular data plan to MA enrollees as a primarily health related supplemental benefit during the public health emergency and/or for the entire plan year? Can we provide a smart phone/tablet or a cellular data plan as a special supplemental benefit for the chronically ill (SSBCI) during the public health emergency and/or for the entire plan year?

A. MA organizations may currently provide smartphones and/or tablets as a supplemental benefit for primarily health related purposes under remote access technology services. Per the 2019 Call Letter and April 2018 HPMS memo, a supplemental benefit is not primarily health related if it is an item or service that is solely or primarily used for cosmetic, comfort, general use, or social determinant purposes.

Therefore, smartphones or tablets must only be used for primarily health related purposes, such as when the
device is locked except for remote monitoring or to enable engagement with healthcare providers.

A cellular data plan can be provided if it is limited to only health related activities (e.g., when the device is locked except for remote monitoring or to enable engagement with healthcare providers). A cellular data plan without limitations can be provided as a non- primarily health related SSBCI to a chronically ill enrollee because SSBCI can include benefits that are not primarily health related so long as the cellular data plan has a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee.

These benefits, within the limits described, may be provided as a COVID-19 permissive action for the duration of the public health emergency (as described in the April 21, 2020 HPMS memo) and/or be included in a bid submission for the entire contract year.

 

7.  Q. Can an MA organization waive the plan premium for an enrollee as a permissive action?

A. Yes, this is within the scope of the April 21, 2020 HPMS Memo if offered to all plan enrollees uniformly. CMS clarifies that this flexibility is limited to when the waiver or reduction in the MA plan’s premium can be tied to the COVID-19 outbreak.

CMS consulted with the HHS Office of Inspector General (OIG) and HHS OIG advised that should an MA organization choose to voluntarily waive or reduce enrollee cost-sharing or plan premium, as approved by CMS in the HPMS memo, such waivers or reductions would satisfy the safe harbor to the Federal anti-kickback statute set forth at 42 CFR 1001.952(l).

CMS also reminds plans of their ability to apply flexible policies to members who are unable to pay plan premiums. Plans are not required under existing regulations to disenroll members due to failure to pay plan premiums; however, plans must apply the same policy consistently for all enrollees of the applicable plan.

For those plans that have elected a policy to disenroll for non-payment of premium, we encourage you to consider changing the policy so that the plan would not disenroll members for non- payment of premium. If a plan chooses not to eliminate its disenrollment policy, we encourage the plan to increase the mandatory grace period (which must be at least two months) to a longer period of time.

Plans may make these types of changes mid-year as long as the change is applied to everyone in the plan and the plan notifies its CMS account manager. This type of change in disenrollment policy may not be limited to specific groups of enrollees but must generally be available to all enrollees in the plan.

Detailed information regarding disenrollment and non-payment of premiums requirements are at § 422.74(b)(1)(i) and section 50.3.1 of Chapter 2 of the Medicare Managed Care Manual for MA and at § 423.44(b)(1)(i) and section 50.3.1 of Chapter 3 of the Medicare Prescription Drug Benefit Manual for Part D.


8. Q. Can an MA organization provide a Rewards and Incentive Program as a permissive action related to the outbreak of COVID-19?

A. Yes, in addition to the permissive actions outlined in the April 21, 2020 HPMS Memo, plans may implement a Rewards and Incentive Program for enrollees in connection with the COVID-19 outbreak. Rewards and/or incentives may not be offered in the form of cash or monetary rebates, including reduced cost-sharing or premiums.

Otherwise, MA organizations have considerable flexibility with regard to what may be offered as a reward or incentive. For example, gift cards are a permissible form of reward or incentive as long as they are not redeemable for cash and meet the applicable limits in the regulation.

MA plans are encouraged to offer enrollees a choice of gift cards from which to choose in order to account for differences in enrollees’ preferences and accessibility of retailers. For additional information, please refer to the Medicare Managed Care Manual, Chapter 4, Section 100.5 – Permissible Rewards and Incentives.

MA-PD Enrollment Projected to Hit 50%

Posted by www.psmbrokerage.com Admin on Tue, May 19, 2020 @ 11:01 AM

MA-PD Enrollment Projected to Hit 50%

MA-PD SHARE OF PART D

The following information is an excerpt from the 2020 annual report of the boards of trustees of the federal hospital insurance and federal supplementary medical insurance trust funds.

There are two ways that employer-sponsored plans can benefit from the Part D program. One way is the retiree drug subsidy (RDS), in which, for qualifying employer-sponsored plans, Medicare subsidizes a portion of their qualifying retiree drug expenses.

As a result of tax deduction changes, RDS program participation has declined significantly since 2012 and is assumed to decline further over the next several years. The Trustees expect that the majority of the retirees losing drug coverage through RDS plans will participate in other Part D plans.

The other way that an employer-sponsored plan can benefit from Part D is to enroll in an employer/union-only group waiver plan (EGWP) by either wrapping around an existing Part D plan or becoming a prescription drug plan itself.

The subsidies for these types of arrangements are generally calculated in the same way as for other Part D plans. The Trustees expect that such plans will offer additional benefits beyond the standard Part D benefit package.

Between 2012 and 2014, EGWP enrollment increased significantly coinciding with the decrease in RDS coverage.

In 2015 and 2016, EGWP enrollment did not change considerably because of the termination of certain EGWPs, which counteracted the continued shift from RDS plans to EGWPs.

Since 2016, steady participation increases in EGWPs have returned, with a vast majority of those increases occurring in Medicare Advantage Prescription Drug Plans (MA-PDs).

MA-PD EGWP enrollment has grown from approximately 2.0 million in 2016 to a projected 2.5 million in 2020; for Prescription Drug Plans (PDPs), onParticipation in MA-PDs has been increasing more rapidly than in PDPs every year except 2013.

In 2010, MA-PD beneficiaries accounted for 36.3% of the enrollment in Part D; this ratio grew to 44.3% in 2019 and is projected to increase to 46.9% in 2020 before reaching 50.7% by 2029.

On the other hand, the number of enrollees has hovered between 4.5 million and 4.6 million over the same time period. Future EGWP enrollment increases are projected but at a slower rate through 2025 due to a declining number of enrollees transferring from RDS plans. Beyond 2025, the Trustees assume that EGWP participation will increase at a rate similar to that for overall Part D enrollment.

This table is a summary of the estimated average enrollment in Part D, by category:


LIS Chart

View the full report here: https://www.cms.gov/files/document/2020-medicare-trustees-report.pdf

 

Tags: Medicare Advantage, Medicare Part D

Consumers Concerned About the Impact of the Pandemic on Their Wallets, Study Shows

Posted by www.psmbrokerage.com Admin on Fri, May 15, 2020 @ 03:32 PM


Consumers Concerned About the Impact of the Pandemic on Their Wallets, Study Shows

While many privately insured members expect to increase their healthcare spending due to coronavirus, almost an equal amount say they will skip their annual exam.

Money,_stethoscope


Coronavirus is changing member and beneficiary healthcare spending habits, including increased telehealth utilization and but lower overall healthcare utilization, a recent PwC Health Research Institute's (HRI's) consumer survey found.


The survey collected data on consumer perspectives about the healthcare landscape before and during the COVID-19 pandemic, including their use of health services and thoughts about how they will interact with the health system in the future.

Delayed doctor visits, procedures and prescriptions could have long-term impacts on health, productivity and costs

Consumers are concerned about the impact of the pandemic on their health and wallets, and are behaving accordingly. Thirty-two percent of survey respondents told HRI that they had already made or were planning adjustments to their spending on healthcare visits as a result COVID-19.

Consumers with exchange plans (45%) or private plans (50%) directly through an insurer were more likely to report that they were adjusting spending on healthcare visits (see figure).

Seventy-eight percent of consumers adjusting their spending said they would skip at least one visit such as a well visit, maintenance visit for a chronic illness, elective procedure or recommended lab test or screening.

Thirty percent predicted that their spending on healthcare visits would increase overall. Implications: Delaying procedures, reducing spending on preventive care and chronic care, and decreasing adherence to medications may have negative long-term impacts on health status, although the extent is unknown.

Healthcare Spending amid CV19 -1



Medicare consumers more likely than others to be skipping routine visits for chronic illness, tests or screenings and electives

Of the consumers who said they already have or plan to adjust their spending on healthcare visits, the privately insured (42%) were more likely than those with public insurance (28%) to say they would skip an annual physical.

Medicare consumers were more likely to say they would skip some of their routine visits for a chronic illness or an elective procedure.

Consumers with a private plan purchased directly from an insurer were more likely (41%) than all other consumers to say they expected to increase their spending on healthcare visits.

Implications: Getting consumers to come back for care may depend on how much trust the health system can build with them over the next few months.

Helping newly unemployed consumers find insurance through Medicaid, ACA insurance exchanges and other means should be a priority for the health system.

Healthcare Spending Amid CV19-2


Read The Full Report:
https://www.pwc.com/us/en/library/covid-19/pdf/pwc-us-health-covid-19-survey-health-insurers_5-11.pdf

 

Tags: health care costs

Older Adults Hit Hard By Job Loss Amid Pandemic

Posted by www.psmbrokerage.com Admin on Thu, May 14, 2020 @ 04:44 PM


Older Adults Hit Hard By Job Loss Amid Pandemic

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This week, the Kaiser Family Foundation (KFF) released data on recent job losses among those age 65 and older, illustrating the ongoing need for economic and insurance assistance for this population.

The unemployment rate among people age 65 and older quadrupled between March and April 2020 from 3.7% to 15.6% (Figure 1). From March to April, 1.2 million adults age 65 and older lost jobs, as did another 2.4 million people ages 55 to 64.

Altogether, people 55 and older account for just under one fourth of all Americans who lost their jobs in April, which is proportional to their share of the workforce. More than 1 in 5 of the nearly 23 million Americans who are now unemployed are older adults (55+).


Older-Adults-Are-Hit-Hard-by-COVID-19-–-and-Also-Losing-Jobs-Figure-1


The economic situation for many older adults has become increasingly difficult. In addition to the economic harm older adults face from job loss, they may also be without health coverage when they need it the most.

Losing coverage in the midst of a pandemic is especially troublesome, particularly for those who may become seriously ill if they are infected with the coronavirus – which is more likely among older adults.

Older adults ages 55-64 may be able to purchase COBRA from a former employer, purchase coverage in the marketplace, or enroll in Medicaid, depending on their individual circumstances.

People ages 65 and older who lose employer-sponsored health insurance along with their jobs can enroll in Medicare if they had deferred enrollment while they continued to work, but this is not an option for younger adults.


Those who are over 65 who have lost job-based coverage may have a Special Enrollment Period (SEP) to enroll in Medicare Part B, but they may face financial penalties or other barriers to coverage. Calls to our national helpline reveal that those who are applying for coverage face delays as they try to enroll because of overwhelming demand.

Others who are eligible for Medicare may have missed out on their opportunity to enroll, leaving them with no coverage at all. The Centers for Medicare & Medicaid Services (CMS) is attempting to make enrollment more flexible for some people, but these options are very narrow and only help a small number of people.

Overall, these grim unemployment statistics reinforce the fact that the coronavirus pandemic is not just a major public health challenge, but also a threat to economic and retirement security for millions of older adults as well.

Read the full KFF report.

 

Over 6M Seniors Could Face Out Of Pocket Costs for COVID 19 Treatment

Posted by www.psmbrokerage.com Admin on Wed, May 13, 2020 @ 04:50 PM


Over 6M Seniors Could Face Out Of Pocket Costs for COVID 19 Treatment

Low-income seniors who do not have supplemental coverage or Medicare Advantage could face out-of-pocket healthcare spending.


More than six million seniors would face COVID-19 treatment out-of-pocket healthcare spending if diagnosed with the coronavirus, a Patient Assistance Network (PAN) Foundation issue brief recently found.

Traditional Medicare and Medicare Advantage cover nearly all of the same coronavirus-related services, including testing, in-person office visits, and telehealth visits. Traditional Medicare and Medicare Advantage will also cover the vaccine when it comes out.

When those who turn to Medicaid and Medicare Advantage are removed from the equation, six million Americans on traditional Medicare are left behind who do not have supplemental coverage. These seniors could be exposed to higher out-of-pocket healthcare spending if they have to face coronavirus treatment.

Seniors in this category also may be low-income. Thirty-seven percent of traditional Medicare beneficiaries who are without supplemental coverage make less than $20,000 annually. These lower income individuals may struggle to afford coronavirus treatment bills.

To ensure that low-income seniors do not face exorbitant healthcare spending and surprise billing due to coronavirus and lack of supplemental coverage, PAN Foundation recommended that CMS move to cap out-of-pocket prescription drug costs. The organization also suggested spreading the costs across the benefit year.

“Medicare beneficiaries are the only group of insured people in the U.S. that is not protected by a cap on annual out-of-pocket costs, forcing many to make difficult trade-offs or to forgo treatment altogether,” the statement argued.

Instead of front-loading surprise bills—draining seniors’ bank accounts of thousands of dollars in the first months of the year—seniors could pay their prescription expenses over time.

Parts of this strategy have been suggested in the Senate and by the Trump Administration. Among the prescription drug spending proposals that policymakers hammered out toward the end of 2019, the Senate Finance Committee approved one that caps beneficiary out-of-pocket healthcare spending at $3,100. The Trump Administration’s 2020 budget included an out-of-pocket spending cap on the Medicare Part D catastrophic phase.

Given these realities, evaluating Medicare’s ability to provide affordable coverage is critical as Medicare forms a safety net for these populations.

Source: https://healthpayerintelligence.com/news/over-6m-seniors-may-face-covid-19-treatment-out-of-pocket-costs

 

Tags: Medicare Advantage, COVID-19

New CMS COVID 19 Related Enrollment Flexibilities

Posted by www.psmbrokerage.com Admin on Mon, May 11, 2020 @ 03:59 PM

Medicare Advantage Insurers Prepared to Assist the Suddenly Uninsured

Posted by www.psmbrokerage.com Admin on Mon, May 11, 2020 @ 02:40 PM

Tags: Medicare Advantage, SEP

Help Feed America with PSM and YourMedicare

Posted by www.psmbrokerage.com Admin on Tue, May 05, 2020 @ 10:06 AM

Tags: Online Enrollment, YourMedicare, Feeding America

Bipartisan lawmakers back efforts to expand telehealth services for seniors

Posted by www.psmbrokerage.com Admin on Mon, May 04, 2020 @ 11:00 AM

Tags: Telehealth

Spotlight on Dental - The Need

Posted by www.psmbrokerage.com Admin on Mon, May 04, 2020 @ 10:52 AM

Tags: Medicare Supplement, mutual of omaha, dental plans

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