The chief executive of Avalere Health, Dan Mendelson, explains that even in cases when switching Part D plans is the most economical option, seniors are still more reluctant to do so. Yet, due to repercussions from health-care laws, there are some changes to the Part D program and it is important to have senior's evaluate their options so they can be assured they are on the best plan for their prescriptions. A new plan from Humana's Wal-Mart-Preferred Rx Plan boasts a $14.80 premium in all regions; however, premiums not only depend on cost but also deductibles, coinsurance, and doughnut hole coverage. Specific details of the Part D plans will be released in time for Annual Enrollment, on November 15th.
Setting New Medicare Skilled Care Service Standards
Two federal courts ruled that the standards for Medicare coverage of skilled nursing home care or home health care are too strict. Before this ruling, Medicare would only pay if a patient's condition would get better with the service, mistaking the belief that Medicare will only pay if treatment makes the patient "better." In correlation with the federal court's ruling, Medicare will now pay for the service if it is needed in order to maintain routine activities in daily life or to prevent the condition from getting worse. This is most significant for those patients with multiple sclerosis, Alzheimer’s disease, and a broken hip who need skilled care to assist them in their daily life.
Medicare Cuts Payments on Prostate Cancer Therapy
In order to curb inappropriate use and save health-care money, Medicare has begun paying physicians less for common prostate cancer therapy. A University of Texas study evaluated how many times adfrogen deprivation therapy was prescribed both before and since the Center for Medicare and Medicaid lowered the reimbursement rates. They found that there was no change in those who needed the treatment; however, it was prescribed 30% less in those who showed no beneficial medical evidence of needing it. These reduced reimbursements caused a positive change in health care by limiting the unnecessary care and driving a new pattern of care. Also, in this prostate cancer therapy case, negative side effects also contributed. Thus, there were both clinical and financial benefits.
Supplier Bidding Contracts Announced
On Thursday the Centers for Medicare and Medicaid Services announced the 356 suppliers who won contracts to provide durable medical equipment for nine areas around the country. With 1,217 contracts signed and 356 suppliers set to produce, prices will be cut by 32% saving a projected $28 billion over the next 10 years. The new program begins in January in Charlotte, Gastonia, Concord, Cincinnati, Middletown, Cleveland, Elyria, Mentor, Dallas, Fort Worth, Arlington, Kansas City (MO & KS), Miami, Fort Lauderdale, Pompano Beach, Orlando, Kissimmee, Pittsburgh, Riverside, San Bernardino, and Ontario. Though, a House bill to repeal the program has attracted 250 sponsors.
Woodmen Plan N Released in LA and AZ
Sources: KHN, The LA Times, The Hill, National Journal