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CMS Maintains Important Changes in Draft 2020 Medicare & You Handbook Julie Carter / May 2, 2019 / Medicare Watch Last year, the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, released a draft version of the annual “Medicare & You” handbook that contained several glaring inaccuracies. In a significant advocacy success, Medicare Rights and our allies convinced CMS to correct these major errors and release a final 2019 handbook that was greatly improved. Read more about our original concerns with the “Medicare & You” handbook in 2019. Read our thank you letter to CMS as a response to the changes to 2019’s “Medicare & You.” Source: https://blog.medicarerights.org/cms-maintains-important-changes-in-draft-2020-medicare-you-handbook |
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Last week, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced that they finished the rollout of new Medicare cards to 61 million people with Medicare ahead of the original deadline of April, 2019. This means that all people with Medicare should now have Medicare cards that include a random Medicare Beneficiary Identifier (MBI) instead of a number based on their Social Security number. |
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Tags: Medicare, CMS, New Medicare Cards
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On April 4, the Centers for Medicare and Medicaid Services (CMS) released the final updates to the Medicare Advantage and Part D programs for 2017. An article from Bloomberg on the same day summarizes the impacts of the increase across the industry. The U.S. is raising payments to the insurers by 0.85 percent on average, according to a statement Monday from the Centers for Medicare and Medicaid Services, down from the 1.35 percent boost proposed in February. Payments to individual insurers can vary, because CMS gives individual plans quality bonuses and premiums are adjusted based on where enrollees live and how sick they are. The smaller increase gives less of an increase to top providers of Medicare Advantage plans such as UnitedHealth Group Inc. and Humana Inc. Other publicly traded insurers that are big providers of the private Medicare plans include Aetna Inc., Centene Corp., and WellCare Health Plans Inc. The U.S. raised rates by about 1.25 percent for this year, after a cut of about 4 percent in 2015. Medicare Advantage plans are run by private health insurers, and funded and regulated by the government. Click here to read the Bloomberg article. |
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Insurers that offer Medicare Advantage health plans are facing less pressure to cut benefits and pull out of some markets next year following a favorable early assessment of factors affecting rates. Late last week, the Centers for Medicare & Medicaid Services (CMS) announced a proposal to hike Medicare Advantage rates by 1.35 percent on average for 2017. While hiking the rates won’t likely come close to covering all costs involved in administering the program, CMS said plans that work toward enhancing the quality of care delivered to enrollees may see advanced updates to cultivating which benefits are offered. Determining how much of an impact the rate hike will have on enrollees is quite difficult to say, but the final rate alteration will vary depending upon factors such as where the plan is located. CMS also floated changes in how risk adjustment would be designed for Medicare Advantage plans that serve many seniors dually eligible for both Medicare and Medicaid. Medicare Advantage plans have undoubtedly become a key source in growth for insurers offering the health plans. With the rate hike, high pressures felt by insurers over recent years due in part to reimbursement cuts called for by the Affordable Care Act (ACA) will slowly start to diminish. Following last week’s announcement, one of the largest Medicare Advantage providers (Humana Inc.) saw shares jump out ahead of the broader market at the start of trading Monday. Humana’s stock increased 2.4 percent, or $3.97 to $169.31, as broader trading indexes climbed around 1 percent. While the final rates for 2017 will be announced in early April, both insurers and enrollees have much to look forward to in the year to come. Interested in selling Medicare Advantage plans? Contact our expert team of Marketers today at + 1 (800) 998-7715 and they'll get you going on the certification process! |
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If you’re a senior market insurance industry professional, chances are you’ve already heard about the changes that the Centers for Medicare and Medicaid Services (CMS) plan to introduce to Medicare Advantage (MA) for 2017. A new analysis from Avalere Health proposed that the suggested modifications to MA could result in large changes in payments for beneficiaries in certain geographic areas. So, how exactly would the risk adjustment affect the pockets of your senior clients?
It adjusts plan payments on an individual basis
Through a process called risk adjustment, CMS fine-tunes its payments to plans based on the expected healthcare costs of each plan’s beneficiaries. For each Medicare beneficiary, the agency calculates a risk score that measures the expected healthcare costs for that individual. The higher the risk score, the greater the expected health care costs, and hence the greater the Medicare payments the government makes to the plan. This means that plans are paid less for a lower risk score and more for a higher risk score. The agency has proposed changes to its risk adjustment model in an effort to address underpayments for certain low-income Medicare beneficiaries (“dual eligibles”), who tend to have higher healthcare costs than other individuals. It creates geographic adjustments in payment, called "county benchmarks"As a result of differences in how states cover dual eligibles, the changes could increase payments for some plans, while dramatically reducing payments for others. The country benchmarks adjust payments for beneficiaries depending upon their location to account for regional variations in the cost of healthcare. In their analysis, Avalere estimates that seven of the 10 counties with the largest MA enrollment as of September 2015 would experience a lower payment rate from the proposed adjustments. For example, Los Angeles would see a decrease of 3.4 percent. Avalere experts also note that the decrease could mean substantial reductions in additional benefits for beneficiaries in this county.
When plans bid to cover beneficiaries within a certain region at less than the cost of the regional benchmark, the extra payment grants "rebates" that can be used to provide enhanced benefitsThe difference between the bid and the benchmark will be reduced, creating fewer opportunities for those rebate-funded benefits and, in turn, fewer additional benefits.
“Because CMS does not plan to publish the 2017 county benchmarks until April 2016, Medicare Advantage plans may want to ask CMS for this information earlier in order to determine the potential impact of these changes and whether or not they would have an adverse impact on beneficiaries,” says Caroline Pearson, Senior Vice President at Avalere.
To read up on the original Avalere Health analysis, please visit: http://avalere.com/expertise/managed-care/insights/proposed-changes-in-medicare-advantage-could-cause-large-shifts-in-payments Sources: www.avalere.com |
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Tags: Medicare Advantage, CMS, Risk Adjustment
 A new policy that informs the public how much money Medicare pays individual doctors may be underway and could violate physicians' privacy rights if poorly handled, warns the American Medical Association.The Department of Health and Human Services (HHS) has announced that it will start responding to Freedom of Information Act requests for physician-payment data. Government officials will be using a ‘balancing test’ to determine who gets access to the information, and not guaranteeing the data to all filed request. This has prompted groups to say the administration needs to do much more in making payment data broadly accessible and transparent. Under the FOIA's privacy exemption, some of the doctor’s information may be kept from public view if the damage to physician privacy is deemed greater than the public interest. Disclosure of the doctor’s data will exclude patients information; however, the information released will depend on the outcome of the “balancing test”, which varies by circumstance, analysis, facts, and per case. In all cases, the HHS says they “are committed to protecting the privacy of Medicare beneficiaries.” In addition, the Center for Medicare & Medicaid will begin “aggregating” data sets about Medicare physician services, 60 days after the new policy appears in the Federal Register. Disclosure of doctor payment data “from government healthcare programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures” says Dr. Ardis Dee Hoven, president of the AMA, who has long opposed the release of data. Over the past 3 decades, Medicare physician-payment data has been highly sought by media groups, government watchdogs and private organizations. They argue that the disclosure of information informs consumers of a doctor’s competence, performance, and highlights any possible abuse or fraud. The release of information should only be done in the efforts of “improving the quality of healthcare services and with appropriate safeguards,” Hoven said. Critics against disclosure argue that the release of information would reveal proprietary details the general public does not need to know, and that inaccurate data presentation would damage a doctor’s reputation. In spite of responding to Freedom of Information Act requests for physician-payment data, the government is not planning to put the entire Medicare physician-payment data online in a searchable format. It will require individuals seeking data to submit specific request under the FOIA’s. Any information that gets released will be filtered and judged by its worthiness, and will take physicians privacy concerns into consideration. On May 2013 a 1979 federal injunction ruling, that barred the release of Medicare payment data and identified doctor’s specifics, was dissolved by U.S. District Judge Marcia Morales Howard in Jacksonville, Fla., ruling on the grounds that physicians' privacy concerns no longer outweighed the public interest. Following the ruling, CMS followed suit to and decided to release physician-payment data, citing disclosure under the Freedom of Information Act. Disclosure of the data will be determined on the outcome of the “balancing test,” as a result every case will be treated as an individual basis (FR Doc. 2014-00808). Please give us your feedback! Question: Will disclosing physician fees help stop Medicare fraud and save money in the long run or will it have an adverse effect and persuade more physicians to stop accepting new Medicare patients? Source: ModernHealthCare |
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Tags: Centers for Medicare & Medicaid Services, Department of Health and Human Services, HHS, physician reimbursement fee, privacy rights, Medicare, Medicaid, CMS
 Big plans to change the way how the private Medicare sector pays brokers and agents are underway and set to appear in the Federal Register on Friday.The Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services (HHS), has included the compensation proposals changes in a batch of regulations that deals with the governing rules of the Medicare wellness program, its incentives and the provisions meant to prevent and attack fraud. The addendum targets current compensation practices of brokers and agents who sell Medicare Advantage plans -- commercial, CMS-subsidized plans that replace traditional Medicare coverage -- and Medicare Part D prescription drug plans. A yearly “fair market value” limit for producer compensation is what CMS wants, states the proposed regulations. In 2014, $400 per year may be considered the fair market value. A plan possibly paying a first year commission that was any amount less than or equal to the fair market value limit, officials say. Commission increase could reach up to 35 percent of the fair market value limit in the following calendar year and the subsequent years. For instance, if in 2014, a producer sold a plan and collected in commission equal to $400, or collected 100% of fair market value, and if the fair market value for 2015 rose to $500, the 2015 year commission would be $175 or 35% of $500 and not 35% of $400 fair market value of previous year, officials say. Many current plans pay 50% in renewal commission for the first-year commission during policy years two through seven, followed by a 25% of the first-year commission in the later years CMS goal is to simplify the commission calculations and level out the playing field. The way to do this is by setting all renewal commission to 35% of the fair market value limit, officials say. To further even out the field, official want to cap out referrals fees at $100 for producers; which, CMS recommended a $100 cap in a memo in 2011. This recommendation is due to the different ways carriers handle referrals, officials say. Please give us your feedback! Question: Will overhauling the Medicare broker compensation even out the playing field, or will it hurt the industry and discourage top producers from reaching or exceeding their goals? Source: LifeHealthPro |
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Tags: Centers for Medicare & Medicaid Services, Medicare Broker Compensation, Medicare Advantage plans, Medicare Advantage, Medicare Part D, CMS
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The CMS (Centers for Medicare and Medicaid Services) has released the maximum commissions a company can pay to an individual producer for 
Tags: Medicare Advantage, Medicare Advantage News, CMS, UnitedHealthcare
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Please give us your feedback! Source: Centers for Medicare and Medicaid Services |
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Last week the Centers for Medicare and Medicaid Services (CMS) released a Medicare Savings Report outlining the Affordable Care Act that will not only improve the care Americans receive but save $120 billion for Medicare through 2015. Some of the improvements including preventive benefits, tying payment to quality standards, investing in patient safety, and offering incentives for those providers who participate in coordinated care have already been implemented.Tags: Medicare Advantage, Medicare News, Assured Life Medicare Supplement, Gerber Life Medicare Supplement, CMS
 Kaiser Health News has an excellent article on how Medicare costs are increasing rapidly in traditionally low cost areas. The article focuses on the city of Provo, Utah where residents are among the healthiest in the country and its largest hospital is operated by Intermountain Healthcare, an organization praised by President Obama for providing high quality care at reasonable costs. Despite these factors, spending on Medicare patients has increased significantly in the last few years.
According to experts cited in the article, the major reason for this spike in spending is the use of expensive, new technologies, (such as the use of robotics for surgery) many of which are said to introduce little to no improvement over traditional methods. They go on to say that competition forces hospitals to adopt the latest technology, as patients always want the “best” care, which they equate to new technology. The new health care law is only going to exacerbate this problem. Now that reimbursement will be tied to quality health care, not only will hospitals be pressured to use the latest tools and techniques, but they most likely will extend patient stays, and use more aggressive (and expensive) treatments at earlier stages of illnesses.
The article goes on to say that what is happening in Provo, Utah is also happening in other traditionally low cost areas of the nation. The biggest concern among experts in the field is that these spikes are indicative of what will happen throughout the country as more hospitals begin to focus on higher quality care for Medicare patients, just at a more severe level.
Medicare Reimbursements Per Enrollee Interactive Map
CMS Will Spend $73 million to Upgrade its Websites |
Tags: senior market blog, senior market news, Medicare Advantage, Medicare, Medicare Supplement, Senior Market, Medicare Discussion, Medicare News, senior insurance market news, CMS