New CMS Projections on Medicare Spending Warrant Scrutiny.

“While Medicare Advantage insurers are excited about getting more flexibility to tailor supplemental benefits for chronically ill patients in 2020, they aren’t happy with the CMS’ plan to increase the use of “encounter data” to calculate their... — While Medicare Advantage insurers are excited about getting more flexibility to tailor supplemental benefits for chronically ill patients in 2020, they aren’t happy with the CMS’ plan to increase the use of “encounter data” to calculate their payments.
In the more than 200 comments on the 2020 Medicare Advantage and Part D Advance Notice and call letter, insurers were generally supportive of CMS’ plan to expand the supplemental benefits that plans may offer their chronically ill patients to include things like nonmedical transportation and home-delivered meals or produce, as called for by the Bipartisan Budget Act of 2018.
Insurers wrote in their comments that they should be able to determine their own definitions of a chronic illness, and some urged the CMS to recognize supplemental benefits that support nutrition, social isolation and home safety as a way to address patients’ social determinants of health.
via Modern Healthcare.
**Related Reading:**
**New CMS Projections on Medicare Spending Warrant Scrutiny.**
A new report from the Urban Institute found that Medicare spending per beneficiary between 2006-2017 was “equal or less” to the increase in per capita GDP. On the other hand, private insurers spent two percentage points more per capita during the same period. Translation: Medicare spends more efficiently on health care than private insurers do.

Source: bit.ly

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ncpssm.org

Two New Reports on Private Medicare Advantage Plans Reveal Real Problems for Seniors

According to a new Government Accountability Office (GAO) report private insurers who offer Medicare Advantage plans need tougher oversight.

via Entitled to Know.

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“More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and... — More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.
via NPR.
Related Reading:
Vast Majority of Private Medicare Advantage Plans Overcharged the Government.

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bit.ly

Behind the Headlines

Broadcasting live from Capitol Hill

Did you miss Behind the Headlines this week?

We discussed:

President Trump’s budget and it’s impact on seniors, Social Security Disability Insurance, and Medicaid.

Medicare Advantage and it’s troubles in Florida.

Mick Mulvaney and his attacks on SSDI.

You can watch it here.

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reut.rs

U.S. government sets 3.40 percent hike in 2019 payments to Medicare...

The U.S. government on Monday said it would increase by 3.40 percent on average 2019 payments to the health insurers that manage Medicare Advantage insurance plans for seniors and the disabled, a higher-than-expected rise reflecting a projection of higher medical cost growth.
via Reuters.

Stay on top of issues like this by signing up for our free newsletter, Your Morning Read, by clicking here.

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nyti.ms

Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?

A lawsuit by the Justice Department accusing an insurer of excessive billing spotlights a paradox of the medical market.

Austin Frakt

The Medicare Advantage program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. The plans now cover 19 million people, a third of all those who qualify for Medicare. Enrollee satisfaction is generally high, and studies show that plans offer higher quality than traditional Medicare. But the government pays insurers more than they pay out for patient care — in some years, it turns out, a great deal more.
via New York Times.

When “Don’t Cut Medicare” Really Means “Protect Private Insurers’ Profits”

The annual lobbying extravaganza by the multi-billion dollar private insurance industry which sells Medicare Advantage plans to seniors, will enter a new phase tomorrow when the Centers for Medicare and Medicaid Services announces it’s 2016 rate schedule. Lobbyists (America’s Health Insurance Plans alone spent nearly $5 million in just six months last year) have been in hyper-drive convincing Washington that trimming their billions of dollars in federal subsidies is the same as cutting seniors’ Medicare benefits. It’s not.

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The National Committee does not oppose Medicare Advantage. For some beneficiaries, it may be the most practical choice – at least while they are relatively young and healthy. But we do believe that the playing field between private plans and original Medicare should be level.

via Trump Administration Continues Tilting the Field toward Medicare Advantage.

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Medicare open enrollment season is supposed to be a time when enrollees can choose the best coverage based on accurate, unbiased information from the federal government. Unfortunately, the Trump administration’s enrollment tools show a continuing bias toward private Medicare Advantage (MA) plans over traditional Medicare.

via Open enrollment tools still favor Medicare Advantage.

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““Medicare is under threat like never before,” Trump said. “Almost every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare.”
Far from “obliterating’’ Medicare, Sanders says his... — “Medicare is under threat like never before,” Trump said. “Almost every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare.”
Far from “obliterating’’ Medicare, Sanders says his plan would lower costs and provide new benefits, including coverage for long-term care. Medicare, which covers about 60 million seniors and disabled people, is the government’s flagship health care program.
Trump also signed an executive order directing his administration to pursue changes to Medicare. Much of what he wants to do is geared toward enhancing Medicare Advantage, the private insurance option picked by about one-third of seniors.
via Washington Post.
**Related Reading:**
**President Trump used a speech at a Florida retirement community to spread falsehoods about Medicare in front of an audience of seniors.**
While the Trump administration pumps up private Medicare Advantage plans with goodies like rides to the doctor and gym memberships, why hasn’t the president supported at least one of several Democratic bills to expand traditional Medicare to include dental, vision, and hearing coverage?
Today’s speech re-emphasizes that the President has bought into the profits-first-patients-second ideology of his key health care advisers, including budget director and acting chief of staff Mick Mulvaney and Medicare administrator Seema Verma, who have never met a government program they don’t want to privatize.

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“Dialysis chain DaVita this week agreed to pay $270 million to settle allegations that physicians in its medical group fudged how sick their patients were so they could get paid more from Medicare Advantage plans — which in turn got higher payments... — Dialysis chain DaVita this week agreed to pay $270 million to settle allegations that physicians in its medical group fudged how sick their patients were so they could get paid more from Medicare Advantage plans — which in turn got higher payments from the federal government.
Why it matters: DaVita’s settlement eliminates a three-year-old probe. But the entire Medicare Advantage industry — estimated to cost the federal government $250 billion in 2019 — remains under the microscope for gaming the payment system.
via Axios.
**Related Reading:**
**Draft Medicare Handbook Biased Toward Private Plans.**
A draft handbook on Medicare enrollment has drawn criticism from senior’s advocates – and rightly so. The Centers for Medicare and Medicaid Services (CMS) released the draft for review in advance of mailing a final version to 43 million households this September.
What bothers advocates is the handbook’s apparent bias toward private Medicare Advantage plans over traditional Medicare – using inaccurate and misleading information.

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NCPSSM — While Medicare Advantage insurers are excited...

See, that’s what the app is perfect for.