Highlights of the report include:
The Trustees show Medicare spending is projected to increase significantly as a share of GDP over the next few decades, with each part of Medicare contributing to the cost growth. In addition, lawmakers face a near-term financial challenge as the HI trust fund will be exhausted by 2026, just seven years from now. Lawmakers need to undertake reforms to Medicare to contain spending growth and ensure HI solvency.
Medicare Spending Is Growing Rapidly
As a share of GDP, gross Medicare spending is expected to grow significantly over the long term, especially over the next few decades.
The Trustees project gross Medicare spending will rise from 3.7 percent of GDP in 2018 to 5.0 percent in 2028 and 5.9 percent by 2040. Spending will continue to increase after that but more slowly, reaching 6.5 percent by 2090.
Medicare Part A is largely financed by a payroll tax, and other parts of Medicare are partially financed through beneficiary premiums. Net of these and other funding sources, spending is lower but still expected to grow significantly from 1.6 percent of GDP in 2018 to 2.6 percent in 2028 and 3.3 percent in 2040 before growing more slowly to 3.5 percent by 2090.
Per-capita increases in health care spending also play a role in Medicare spending increases, as nominal per-person Medicare spending is expected to increase by 65 percent – from $13,665 to $22,546 – between 2018 and 2028. This increase is larger than the 56 percent growth in the economy that is expected to occur over the same time period.
All Parts of Medicare Are Growing
The Medicare program comprises three main components: Part A covers inpatient care in hospitals and other facilities, Part B covers physician and outpatient care, and Part D covers prescription drugs.
Part A spending is projected to increase from 1.5 percent of GDP in 2018 to 2.2 percent in 2040 before growing more gradually to 2.3 percent by 2090. Part B follows a similar but faster-growing trend, increasing from 1.7 percent of GDP in 2018 to 3.0 percent in 2040 and 3.1 percent by 2090. Part D is the smallest but fastest-growing over the next 75 years, rising from 0.5 percent of GDP in 2018 to 0.8 percent in 2040 and 1.1 percent in 2090.
For the SMI trust fund, general revenue contributions and beneficiary premiums are set annually to cover program costs so the trust fund is always solvent by definition. Nevertheless, spending for Parts B and D is expected to grow significantly relative to GDP, putting pressure on the federal budget and on beneficiaries through higher premiums and out-of-pocket costs.
The Hospital Insurance Trust Fund Is Seven Years from Insolvency
The Trustees project the Part A Hospital Insurance (HI) trust fund will be exhausted in 2026, just seven years from now. At that time, spending would have to be reduced by 11 percent to be brought in line with revenue.
Both HI spending and revenue are expected to increase over time as a share of payroll, but spending will grow much more rapidly in the next few decades. HI spending will increase from 3.4 percent of payroll in 2018 to 4.2 percent by 2028 and 4.9 percent by 2040 before growing more slowly to 5.3 percent by 2090. Revenue will grow steadily from 3.3 percent in 2018 to 3.6 percent in 2028, 3.8 percent in 2040, and 4.4 percent by 2090.
Part B and D Spending Growth Will Put Pressure on the Budget
The Trustees project that both Parts B and D will grow faster than the economy because of growth in the eligible population and in spending per eligible beneficiary. As pointed out above, these parts are financed by general revenue as necessary, so they can’t become insolvent but their growth has other implications. The Trustees point out that absent changes in law, the growth in spending will require a growing share of federal income tax revenue and premiums and out-of-pocket spending will make up a growing share of beneficiary income.
The Trustees project spending for Parts B and D will increase from 2.1 percent of GDP in 2018 to 3.7 percent by 2040. We estimate this increase in program spending will cause beneficiary out-of-pocket costs to increase from 1 percent of GDP in 2018 to 1.8 percent by 2040.
Medicare Blog | Medicare News | Medicare Information
Humana Certification & Recertification Course Details for Plan Year 2020!
Top 4 Improvements:
Certification & Recertification Launch Dates
*NOTE: Does not include Spanish translation. Spanish versions will be available on a delayed basis. Look for additional communications on Spanish versions.
Recertification Completion Deadlines
Nearly two-thirds of insurance agents reported increased sales of Medicare supplement insurance in 2018 and a higher percentage expect continued growth in 2019, according to a survey conducted by the American Association for Medicare Supplement Insurance.
"The vast majority of agents (64.1%) experienced increased Medigap sales in 2018 compared to the prior year," reports Jesse Slome, director of the association.
The organization polled 1,000 insurance professionals who market Medicare insurance in advance of the association's national Medicare Supplement industry conference. Over 300 agents completed the survey questions.
Some 64.1 percent of the agents reported increased or higher sales of Medigap insurance in 2018. Just over one-in-four (27.2%) indicated that their sales were about the same as the prior year with only 8.7 percent reporting decreased or lower sales.
The association asked agents to predict their 2019 sales compared to 2018.
"An ever greater majority of agents (68.6%) were more optimistic that their Medigap sales during the year would be higher," Slome said. "The percentage who expect decreased sales dropped to 3.8 percent.
"With 11,000 Americans turning 65 daily, it's no wonder why more agents are focusing on selling Medicare Supplement and Medicare Advantage products," he added. "There is every reason to be optimistic about the future and the continued growth of the industry."
By Taylor McDonald – CSG Actuarial – May 7, 2019
CSG Actuarial, with information from the NAIC and other sources, reports total earned premiums in the Medicare Supplement market in 2018 totaled $32.4 billion, a 4.9% increase over 2017. The total Med Supp lives covered in 2018 increased to 14.05 million, up 3.9% from 2017. The top 12 carriers in terms of 2018 Medicare Supplement premiums were:
The 2018 overall Med Supp market loss ratio of 79.0% reflects a continued trend in the market of the overall loss ratios creeping back up towards “Pre-Modernized” levels of around 80%.
By Shelby Livingston – ModernHealthCare – May 7, 2019
The health insurance industry often attributes lower spending among Medicare Advantage seniors compared with those in traditional Medicare to care management strategies. But a study published Monday turns that claim on its head.
Researchers at the Kaiser Family Foundation found that traditional Medicare beneficiaries who opt to enroll in a Medicare Advantage plan offered by a private health insurer have lower average spending and use fewer services—before they ever switch to Medicare Advantage—than their counterparts who stay in traditional Medicare. The findings raise questions about how much Advantage plans actually lower spending.
Moreover, the results suggest that the CMS, which uses traditional Medicare spending to calculate Advantage payments, overpays Medicare Advantage plans to the tune of billions of dollars each year, the researchers concluded. A little more than a third of the 60 million Medicare enrollees are in an Advantage plan. The CMS paid Medicare Advantage insurers about $233 billion in 2018, a figure expected to grow as more seniors choose Advantage plans.
"Medicare Advantage plans are perhaps getting paid more than the actual expected costs of their enrollees," said Gretchen Jacobson, a Kaiser Family Foundation associate director who co-authored the study.
Researchers looked at average Medicare Part A and B spending among people who were enrolled in traditional Medicare in 2015. Those enrollees who switched to a Medicare Advantage plan in 2016 spent $1,253 less in 2015 on average than beneficiaries who did not switch, after controlling for health risks.
By the Kaiser Family Foundation – May 7, 2019
People on Medicare can choose coverage from either traditional Medicare or Medicare Advantage plans, typically trading off broad access to providers for potentially lower premiums and out-of-pocket costs. Beneficiaries who choose Medicare Advantage may differ from those in traditional Medicare in both measurable and unmeasurable ways, which may influence their use of services and spending. Yet, Medicare payments to Medicare Advantage plans per enrollee are based on average spending among beneficiaries in traditional Medicare.
This analysis looks at whether beneficiaries who choose to enroll in Medicare Advantage plans have lower spending, on average – before they enroll in Medicare Advantage plans – than similar people who remain in traditional Medicare. We compare average traditional Medicare spending and use of services in 2015 among beneficiaries who switched to Medicare Advantage plans in 2016 with those who remained in traditional Medicare that year, after adjusting for health risk. We adjust Medicare spending values for health conditions and other factors, with a model similar to the CMS HCC Risk Adjustment Model that is used to adjust payments to Medicare Advantage plans (see Methods).
Even after risk adjustment, the results indicate that beneficiaries who choose Medicare Advantage have lower Medicare spending – before they enroll in Medicare Advantage plans – than similar beneficiaries who remain in traditional Medicare, suggesting that basing payments to plans on the spending of those in traditional Medicare may systematically overestimate expected costs of Medicare Advantage enrollees.
Virtual Care for Medicare Advantage
Under the Centers for Medicare & Medicaid Services (CMS) proposed rule issued on October 26, 2018, Medicare Advantage plans will be able to provide “additional telehealth benefits” as basic benefits for purposes of bid submission and payment by CMS beginning in the 2020 plan year. With this landmark regulatory shift that expands reimbursement for virtual care services, CMS has opened the door for the advancement of differentiated offerings reliant on innovative care models.
A comprehensive virtual care strategy provides a pathway for health plans to expand their Medicare Advantage offerings by:
Medicare Advantage represents a significant growth opportunity for health plans serving the 65-plus consumer population. Recognizing the expansive and changing needs of this group—the “age-ins” along with the older demographic—the most-successful health plans will pivot quickly to partner with a trusted and proven virtual care provider to unlock value by incorporating comprehensive, scalable, and innovative strategies.
Last week’s Medicare Trustees’ report predicts the Part A Hospital Insurance (HI) trust fund will be partially depleted in 2026. This is the same as last year’s projection, and three years earlier than in 2017—the last report issued before the GOP tax bill took effect.
This is not a coincidence. The 2017 tax bill directly cut funding for the Part A Trust Fund by significantly reducing one of its primary revenue streams—the taxation of Social Security benefits. It also caused some of the projected growth in Part A expenditures. By zeroing out the Affordable Care Act’s individual mandate, the tax bill also increased the number of uninsured—driving up Medicare hospital payments for uncompensated care. Higher spending projections can also be attributed to the tax bill’s repeal of the Independent Payment Advisory Board, which would have helped to control Medicare spending if the growth rate exceeded certain target levels.
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.
The Bold Goal program has improved population health for Humana Medicare Advantage members since 2015.
By Jessica Kent – HealthPayerIntelligence – April 25, 2019
Medicare Advantage members living in Humana’s seven original Bold Goal communities have seen an improvement in population health, with these individuals experiencing a 2.7 percent reduction in their Unhealthy Days since 2015, according to Humana’s 2019 Bold Goal Progress Report.
Humana’s Bold Goal program aims to improve the health of the communities it serves 20 percent by 2020 and beyond. Since the program began, Humana has used the CDC’s health-related quality of life measurement, known as Healthy Days, to track and trend progress.
Healthy Days takes the whole person into account by measuring self-reported physically and mentally unhealthy days over a 30-day period. The healthy days measurement aligns with the Bold Goal’s aim to address individuals’ physical well-being, along with the social determinants of health, such as food insecurity, loneliness, and social isolation.
San Antonio, the first Bold Goal community, is halfway to its 20 percent healthier goal, with members in this area experiencing a 9.8 reduction in unhealthy days. Humana worked with community organizations, physician practices, and others to screen 500,000 members, employees, and patients for social determinants of health in 2018, leading to the gains in everyday wellness.
The report stated that on average, a Humana Medicare Advantage member who is food insecure may experience 26.6 unhealthy days, while Medicare Advantage members who experience loneliness may see an average of 24.4 unhealthy days.
Humana noted that of those experiencing food insecurity, 66 percent have to choose between food and medical care. Food insecure members are also 50 percent more likely to be diabetic and 60 percent more likely to have congestive heart failure.
Those experiencing loneliness and social isolation are four times more likely to be re-hospitalized within a year of discharge, and 64 percent more likely to develop dementia.
These non-clinical influences can also have detrimental effects on mental health. For those Bold Goal communities that did not see significant improvements in population health, Humana stated that one of the contributing factors was a higher number of mentally unhealthy days versus physically unhealthy days.
“Throughout the country, we are seeing a rise in mental health concerns as well as loneliness and social isolation, especially in our aging adult population. In fact, since the 1980s, the rates of loneliness in adults over the age of 45 have doubled,” said Caraline Coats, Vice President of Bold Goal and Population Health Strategy.
“With the knowledge that mentally unhealthy days and new membership are driving many of our results, several of our Bold Goal communities are looking at ways to address this growing need. We’ve already seen efforts emerge in Tampa Bay, New Orleans and Louisville.”
In Louisville, Kentucky, the Louisville Health Advisory Board’s Behavioral Health Committee trained more than 2200 volunteers in emergency response techniques designed to prevent suicide.
The Tampa Bay Bold Goal Health Collaborative has also been focused on addressing the behavioral health needs of members, partnering with mental health professionals, faith-based organizations, and other stakeholders.
In addition to the social determinants of health, the Bold Goal program aims to improve population health by managing chronic conditions. Nearly 77 percent of Americans aged 65 or older are living with two or more chronic conditions, the report said, making chronic disease management imperative for overall health.
“A large part of Humana’s focus is to help people living with multiple chronic conditions improve their health, which requires an integrated approach,” said Bruce D. Broussard, Humana’s President and CEO.
“The Bold Goal is not just our north star; it’s a quantitative way for us to address the holistic needs of multiple populations, and to measure our progress. This year’s report reflects our track record of success in managing chronic conditions over time. Given current demographic trends, we expect to see continued demand for a support structure that addresses social needs, along with clinical ones.”
In Knoxville, Tennessee, the Knoxville Health Advisory Board has focused on addressing diabetes, which has led to positive trends for low-income Humana Medicare members. These individuals experienced a 2.9 reduction in unhealthy days in 2018.
Going forward, Humana and its Bold Goal communities will continue to address the many factors that influence well-being, with an understanding of the important roles physical, mental, and social elements play in members’ overall health.
“The social barriers and health challenges that our Medicare Advantage members and others face are deeply personal,” said William Shrank, MD, Humana’s Chief Medical Officer.
“This requires us to become their trusted advocate that can partner with them to understand, navigate and address these barriers and challenges. With Healthy Days as our barometer, we are able to track and trend population health, measure outcomes and triage members in unique ways to the resources they need.”