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How the ACA is Changing Medicare

Posted by www.psmbrokerage.com Admin on Thu, Jun 11, 2015 @ 03:01 PM

blog pic The aims of the Affordable Care Act (ACA) were to increase health insurance coverage for those under age 65, improve the performance of the health care delivery system, and slow cost growth. Less recognized are the provisions of the law that seek to strengthen the Medicare program.

The ACA addresses gaps in Medicare preventive and prescription drug benefits. It initiates ambitious testing of new payment methods to improve the value of care received by beneficiaries and, indirectly, all Americans. And it substantially extends the solvency of the Medicare Health Insurance Trust Fund by slowing the growth of future Medicare outlays.

By moving Medicare away from fee-for-service payment and by holding health care providers accountable for both the quality and total cost of care, certain ACA reforms have the potential to reshape not just the Medicare program but the entire U.S. health care system. For example, the law’s creation of the Center for Medicare and Medicaid Innovation (CMMI) will enable Medicare to test innovative models of provider payment and service delivery and expand those that demonstrate promise to improve beneficiary outcomes and patient experiences of care or lower cost. The projects initiated by the CMMI are just now beginning to produce results; significant work remains to identify and spread successful payment innovations.

The ACA also makes important changes to the Medicare Advantage (MA) program, through which enrollees can choose to receive their Medicare benefits from private plans. Payment rates to MA plans are to be constrained until those plans are on a par with traditional Medicare, though financial rewards are available for plans achieving high performance ratings. These changes are intended to provide incentives for MA plans to improve quality and patients’ health care experiences and encourage beneficiaries to choose plans with higher quality and lower cost.

While these new policies strengthen Medicare, they were not intended to address some of the serious challenges facing Medicare in the future. Without additional changes, the retirement of the post–World War II generation will cause total Medicare outlays to outpace growth in the economy, claim an increasing share of the federal budget, and exceed the revenues currently dedicated to the Medicare program.

As currently configured, Medicare benefits do not adequately address the financial and health care needs of future beneficiaries—particularly the poorest and sickest among them. Traditional Medicare’s benefit design reflects the fragmented nature of health care delivery, with separate hospital, physician, and prescription drug benefits adding to the complexity, administrative cost, and difficulty of coordinating care. The predominantly fee-for-service provider payment system used by traditional Medicare, and by most MA plans, provides no incentive to eliminate duplicative or ineffective care, coordinate care, or substitute lower-cost care alternatives—and in effect penalizes providers who do so. This mismatch between benefits and needs will be an increasing source of concern as families struggle with out-of-pocket costs, serious health conditions, and inadequate options for caring for family members with physical and cognitive functional impairments.

While the ACA’s reforms hold significant potential to make Medicare more viable and successful in the future, Medicare’s long-term fiscal solvency, complexity, and gaps in coverage remain unaddressed. As millions of Americans age into Medicare, federal budgetary pressures will inevitably focus attention on more fundamental reform of the program.

Read the full document here





http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare...

Source: commonwealthfund.com

Additional Updates:

Tags: Obamacare, Affordable Care Act, medicare changes

Closing the gap on the 'Doughnut Hole'

Posted by Guadalupe Cantu on Fri, Oct 11, 2013 @ 11:43 AM

Medicare Supplements The Affordable Care Act rollout last week was not all smooth sailing. It faced multitudes of glitches and hiccups online; as well as, offline. Despite its rocky start, the Affordable Care Act aims to reduce the Medicare coverage gap, also known as the "doughnut hole," by 2014 and completely close it by 2020, according to Medicare.gov.

Before the Affordable Care Act, benefactors would have to pay their insurance yearly deductible in out-of-pocket cost until their medical expense limit reached the copay of $4500.00, before any coverage premiums would kick in.

In 2014, with the Affordable Care Act, beneficiaries begin with the monthly Part D premiums and pays 100% of the drug cost until satisfying the $310 deductible. Then the plan pays for the rest of the cost of the medicine until hitting the expenses cap of $2850.00; a 25% out-of-pocket drop in copay. That’s when seniors are faced with the doughnut hole, once more.

The dreaded “doughnut hole” – is the difference seniors out-of-pocket drug expenses begins, after their Part D premiums coverage cap has been exceeded, and before they are eligible for the amount the government pays for "catastrophic" drug coverage.

Since 2010, the Medicare gap has been slowly closing through steady drug discounts. This is largely due to the government reaching out to pharmaceutical industry and bargaining for drug discounts. Discounts for brand name drugs and generic will continue. By next year, were expected to pay 47.5% for premium brand pharmaceuticals names and 72% for generic ones.

By 2020, Medicare Part D enrollees will save 75% on both premium and generic medication, according to the Centers for Medicare & Medicaid Service.


Please give us your feedback!
Is the ACA program better than what we had before? Do you think it will truly make Insurance more competitive and affordable?

 

Source: LifeHealthPro & Centers for Medicare & Medicaid Service

Additional Updates:
    • 2014 Medicare Advantage and Part D Certifications are now available! Learn More

Tags: Obamacare, Doughnut Hole, Part D Premiums, Medicare, Affordable Care Act, Affordable Care

The narrowing of Medicare Advantage plans

Posted by Guadalupe Cantu on Fri, Sep 27, 2013 @ 10:00 AM

Medicare Supplements It’s no big secret that the government was looking for a way to pave the way for an entirely new health reform. A cost control measure, which would save over $132 billion within a 10 year span. The government found it through the budget cuts changes they made to Medicare Advantage.

In 2014, the Medicare Advantage plans available will decrease from to 2,664 plans in 2013 to 2,522,, a difference 5.3 percent, according to Avalere Health analyst.

Further driving the decline of Medicare Advantage plans is the Affordable Care Act payment cuts. Beginning 2014, Medicare Advantage plans are required by law, to lower cost and use 85 percent of their revenue on medical care and quality improvement efforts. Any Medicare Advantage participants who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of non compliance. Not all news is bad for Medicare Advantage plans. Quality bonus programs have been developed to reward plans that are higher in quality and more efficient than their counterparts, reports Centers for Medicare and Medicaid.

According to Peter Kongstvedt, MD, a noted insurance industry consultant and a member of MANAGED CARE’s editorial advisory board, the Medicare Advantage HMOs will do well because their rates are often below the fee-for-service equivalents and they have a track record of doing well in the past. He also believes Medicare Advantage PPOs will fare well.


Please give us your feedback!
What does this all mean to the seniors? Under the Affordable Care Act, everyone has the right to health insurance. Do you believe “the law” will help decrease rates?

 

Source: LifeHealthPro & Managed Care Magazine

Additional Updates:
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      October Med Supp Outlines for CA, DE, GA, IL, KS, MS, NC, ND, OH, PA, TN, WI, WV. Learn More

      October Med SELECT Outlines for MS, NC, OH, PA, TN. Learn More

      September Med Supp Rates for ID, IN, WY. Learn More

    • 2014 Medicare Advantage and Part D Certifications are now available! Learn More

Tags: Medicare Advantage, Medicare Supplement, Medicare Advantage News, Medicare Part D, Affordable Care Act, Affordable Care, HMO

Confusion lingers over Medicare benefits and the health care law

Posted by Guadalupe Cantu on Fri, Sep 20, 2013 @ 02:33 PM

Medicare Supplements With looming deadlines of October 15, for Medicare’s traditional open enrollment date, and the overlap of the first enrollment period for Patient Protection and Affordable Care Act set to start on October 1 – December 7, has caused a lot of confusion among seniors over their coverage.

Adding to the confusion is the increased media frenzy reporting of the state exchanges for individuals 65 and under, and insurance companies offering coverage to both the new exchanges and to Medicare recipients.

Federal health officials have stepped up the efforts to let seniors know they have nothing to worry about and that the Medicare benefits are not changing under the Affordable Care Act. They want Medicare recipients to know that the enrollment period of Oct 15th – Dec. 7th, will be business as usual and seniors will be able to sign up to new plans by continuing to go to Medicare.gov.

Federal health officials have ramped up their call centers, training for Medicare counselors and website. This is in preparation to the influx of calls they will be receiving in October, in anticipation of the 50 million Medicare beneficiaries who will be mailed a handbook with a prominent Q&A, stressing their benefits aren't changing. Calls are already being rerouted to Medicare call center from the state exchanges call centers, said Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services.

Worries still linger within the senior community despite federal efforts to stem down the confusion. Under the Affordable Care Act, seniors will not be able to purchase Medicare supplemental insurance or Part D drug plans through the state exchanges. This is what worries seniors such as, 72 year old Bob Roza who actively attended meetings in order to find out what ACA was and how it would affect him and his 69 year old wife with diabetes.

Roza, who underwent hip replacement this year, now worries how the ACA will affect his $614 monthly fee and his Medicare supplemental insurance, in spite of his Medicare coverage.

Advocacy groups have also taken an interest on the matter. They feel the federal health officials have put most of its efforts on those who already are on Medicare and have not done enough outreach to inform seniors without Medicare, said Jodi Reid, executive director of the California Alliance for Retired Americans. She feels that advocacy groups have picked up the tab and are using the majority of their advertising dollars to inform seniors affected by the exchange. Her group has put together a one-page fact sheet to educate nearly 1 million California seniors.

Officials of the AARP said they are organizing several events around the country, hosting 21 telephone town halls to clarify questions to seniors who are either Medicare or Non Medicare recipients.

As the Affordable Care Act inches closer, advocates are warning seniors not to give any personal information. To watch out for scams that may surface alongside legitimate Affordable Care Act outreach.


Please give us your feedback!
Do you feel there is still a tough job ahead to inform seniors about what the Affordable Care Act is and how it impacts Medicare? Do you believe all the outreach efforts from advocates and federal health officials will help millions of uninsured people to sign up for coverage by the end of March or will just stir more confusion?

 

Source: LifeHealthPro

Additional Updates:
    • Omaha Insurance: New Med Supp release in Nebraska
      Med Supp Application for NE.Learn More

      Med Supp Rates for NE. Learn More

Tags: Medicare open enrollment, Medicare benefits, health care law, Health Insurance, health insurance news, Medicare Part D, Affordable Care Act, health care reform

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