Category: Medicare Advantage

Medicare To Offer Help To Some Seniors When Advantage Plans Drop Doctors

December 22, 2014

By Susan Jaffe | December 22, 2014 | Kaiser Health News and also published in

Starting next year, the government will offer some seniors enrolled in private Medicare Advantage insurance an opportunity to leave those plans if they lose their doctors or other health care providers.

Last year, thousands of seniors in at least 10 states were left stranded or assigned new doctors when insurers discontinued contracts with the physicians. Medicare Advantage policies cover 16 million seniors and are an alternative to the government-run Medicare program. Medicare Advantage members can only get care from a network of providers under contract to participate in their plan. They must remain in their plans for the calendar year, with some rare exceptions, but losing their doctor has not been among the permitted reasons. [More from KHN] [More in USA Today]

…

Medicare Testing Payment Options That Could End Observation Care Penalties

July 22, 2014

By Susan Jaffe KAISER HEALTH NEWS | July 22, 2014 | This KHN story also ran in

Medicare officials have allowed patients at dozens of hospitals participating in pilot projects across the country to be exempted from the controversial requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days.

The idea behind these experiments is to find out whether new payment arrangements with the hospitals and other health care providers that drop the three-day rule can reduce costs or keep them the same while improving the quality of care. They are conducted under a provision of the Affordable Care Act that created the Center for Medicare and Medicaid Innovations to develop ways of improving Medicare.

If the experiment saves Medicare money and improves care, “we should be able to make an argument to Medicare that there is a way to do it for all our patients,” said Dr. Eric Weil, clinical affairs associate chief for the general internal medicine division at Massachusetts General Hospital in Boston. The hospital is one of five in the Partners Health System that began offering the waiver in April, after testing a limited version.

“It gets patients to the care they need much quicker and prevents them from clinically declining at home,” said Weil. If patients can spend less time in the hospital, he said that frees up valuable resources for sicker patients. And it saves money for Medicare because nursing home care or home health care is cheaper than a hospital stay. [Continued in KHN] [Continued in Washington Post]…

Feds Issue Rules To Protect Seniors Enrolled In Medicare Advantage Plans

April 8, 2014

By Susan Jaffe | April 8, 2014, 5:46 pm
Connecticut Health Investigative Team and The Hartford Courant

UnitedHealthcare’s decision last fall to drop thousands of doctors from its Medicare Advantage plans in Connecticut and across the country has spurred Medicare officials to improve protections for seniors who lose their doctors.The new measures were announced late Monday along with a slight increase in next year’s payment rates to Medicare Advantage insurers who provide policies as an alternative to the traditional government-run Medicare program.

Nearly 16 million older Americans have enrolled in a Medicare Advantage plan, including more than 147,000 in Connecticut, which requires members to get treatment only from a network of health care providers. They cannot change plans during the year if their doctor leaves their network….

“I doubt that CMS would have given this as much attention without patients, providers and advocates demonstrating how deep and broad the effect was and how much pain and anguish it caused,” said U.S. Sen. Richard Blumenthal. CONTINUED in Connecticut Health Investigative Team CONTINUED in The Courant …

Draft Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors

March 24, 2014

By Susan Jaffe March 24, 2014 KAISER HEALTH NEWS in collaboration with

Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other health care providers. The proposals follow UnitedHealthcare’s decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall.

The government’s response is part of the 148-page announcement of proposed rules and payment rates for next year’s Medicare Advantage plans released last month by the U.S. Centers for Medicare & Medicaid Services. Officials say that the terminations only a few weeks before Medicare’s Dec. 7 enrollment deadline may not have given seniors enough time to find new doctors, choose a different plan or rejoin traditional Medicare, which does not restrict beneficiaries to a limited network of providers.

…Although the announcement does not name any insurance companies, officials prefaced the proposals by writing, “Recent significant mid-year changes to MAOs’ [Medicare Advantage organizations’] provider networks have prompted CMS to reexamine its current guidance on these requirements and to consider augmenting such guidance in response to such changes.” [More from KHN] [More from Washington Post]…

Link

Judge’s Medicare Advantage Order Could Have National Impact

By Susan Jaffe | December 6, 2013 | Kaiser Health News produced in collaboration with

In a decision that could have national implications, a federal judge in Connecticut temporarily blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state. While the judge’s decision affects only the physicians in Fairfield and Hartford Counties who brought suit, several other medical groups are considering filing similar actions.

“This is very good news from Connecticut,” said Dr. Sam L. Unterricht, president of the Medical Society of the State of New York. “We will definitely seriously consider filing a suit in New York as well.” [Continued in Kaiser Health News and USA Today]

Link

By Susan Jaffe | November 29, 2013 | Kaiser Health News produced in collaboration with

Dorathy Senay’s doctor had some bad news after her last checkup, but it wasn’t about her serious blood disorder called amyloidosis. Her Medicare Advantage managed care plan from UnitedHealthcare/AARP is terminating the doctor’s contract Feb. 1. She is also losing her oncologist at the prestigious Yale Medical Group — the entire 1,200 physician practice was axed. Senay, 71, of Canterbury, Conn., is among thousands of UnitedHealthcare Medicare members in 10 states whose doctors will be cut from their plan network.

The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members. More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s network of providers.

“I have a rare incurable disease and these doctors have saved my life,” said Senay. “I am in good hands and I will not change doctors.”

…Medicare officials review the private plans every year to make sure they comply with network adequacy and other requirements, but the agency did not approve the reconfigured networks resulting from the new provider cancelations. Spokesman Raymond Thorn said the agency “is currently reviewing UHC and other plans’ provider networks and closely monitoring all areas that have experienced disruptions to ensure that beneficiaries have full, transparent and timely information and access to needed care.” [More from KHN] [More in USA Today]

Link

By Susan Jaffe | October 15, 2013 | Kaiser Health News produced in collaboration with

The seven-week enrollment period for next year’s Medicare prescription drug and managed-care plans begins Tuesday, but seniors shouldn’t simply renew their policies and assume the current coverage will stay the same. There’s a likely payoff for those who pay close attention to the details.[More in KHN] [More in USA Today]

Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

Link

By Susan Jaffe | October 11, 2013, 6:24 pm

Shirley Mierzejewski was “very upset” when she found out her Medicare health insurance premiums will nearly double next year.

“I cannot afford that, I cannot,” said Ms. Mierzejewski, 77, who lives in Euclid, Ohio, and works part time as a receptionist at a local college. She has a private Medicare Advantage policy from Anthem, which provides drug and medical coverage.

“So I started thinking about the marketplaces,” she said, referring to the online insurance exchanges created by the Affordable Care Act. “Maybe I could find something cheaper there.”

While thousands of Americans are trying to sign up for insurance on the exchanges, Medicare counselors like Semanthie

Brooks, who spoke at the meeting Monday in Euclid, are trying to steer seniors away. They worry that Ms. Mierzejewski and other older adults may not realize that Medicare is a pretty good deal compared to exchange policies and may try to buy one anyway.

…To clear up confusion in Montgomery County, Md., officials held meetings at six centers for the elderly. “They want to know if they are better off in the exchange than in Medicare,” said Leta Blank, director of the Montgomery County State Health Insurance Assistance Program. “Everyone is looking for a less expensive way to get health care.”

So in a year in which the insurance market is being turned upside down, here are some shopping tips for people with Medicare and caregivers. MORE

Q & A: Medicare and the Insurance Exchanges

Link

By Susan Jaffe | Sept.13, 2013 | KAISER HEALTH NEWS in collaboration with

After reassuring seniors that Medicare is not part of the new health insurance marketplaces, administration officials have a warning for anyone who may have other ideas: selling marketplace coverage to people who have Medicare is illegal.

Federal officials are eager to get the word out that seniors and disabled individuals enrolled in Medicare Part A — which covers hospitalization and limited nursing home care and is free for most beneficiaries – do not need to buy a marketplace plan, because they are already meeting the insurance requirements.

And no one needs to sell them one, either, according to information on a new “Medicare & the Marketplace” government webpage and in a “frequently asked questions” flyer officials recently distributed to Medicare counselors and other seniors advocates. MORE

Link

FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries

By Susan Jaffe | September 4, 2013 | KAISER HEALTH NEWS

Some seniors think Medicare made a mistake. Others are just stunned when they find out that being in a hospital for days doesn’t always mean they were actually admitted.

Instead, they received observation care, considered by Medicare to be an outpatient service. Yet, a recent government investigation found that observation patients often have the same health problems as those who are admitted. But the observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits. Here are some common questions and answers about observation care and the coverage gap that can result. [Continued here]

FAQ: Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services

June 25, 2013

By Susan Jaffe | June 25, 2013 | Kaiser Health News in collaboration with

For years, seniors in Medicare have been told that if they don’t improve when getting physical therapy or other skilled care, that care won’t be paid for. No progress, no Medicare coverage — unless the problem got worse, in which case the treatment could resume.
This frustrating Catch-22 spurred a class-action lawsuit against Health and Human Services Secretary Kathleen Sebelius. In January, a federal judge approved a settlement in which the government agreed that this “improvement standard” is not necessary to receive coverage.

“This will help a lot of older or disabled people who clearly need the skilled care and aren’t getting it because they will not get better,” said Margaret Murphy, associate director of the Center for Medicare Advocacy, which helped bring the lawsuit. “The settlement recognizes that Medicare will pay for care to maintain their condition and prevent backsliding.”

Yet providers may not know about the settlement yet and may still be telling patients, incorrectly, that Medicare won’t cover treatment if there’s no improvement. MORE

…

Link

November 9, 2012, 6:17 pm

By SUSAN JAFFE

Medicare beneficiaries battered by Hurricane Sandy have one fewer problem to worry about: Federal officials have extended the Dec. 7 deadline to enroll in a private medical or drug plan for next year for those still coping with storm damage.

The extra time also applies to any beneficiaries who normally get help from family members or others to sort through dozens of plans, but who have been unable to do so this year because they live in areas affected by the storm. Neither beneficiaries nor those who provide them assistance will be required to prove that they experienced storm damage.

Medicare officials have not set a new deadline but have encouraged beneficiaries to make their decisions soon if possible.[MORE]

More Time to Enroll in Medicare If You Live in Storm Areas

Link

Susan Jaffe | November 5. 2012 | Kaiser Health News produced in collaboration with

Medicare officials are trying a novel approach during this open enrollment season to gently nudge a half million beneficiaries out of 26 private drug and medical plans that have performed poorly in the past three years. It begins with letters informing seniors they are enrolled in a plan that received low ratings.

The effort marks the first time that Medicare officials have tried to steer beneficiaries away from some private drug and medical plans, while still allowing them to operate. Officials have also warned the plans that they might be canceled in the future. [More] [List of the 26 plans and areas served available here].

Link

By Susan Jaffe

October 15, 2012, 6:00 AM KAISER HEALTH NEWS

Today, Medicare beneficiaries can begin choosing their drug and medical coverage for 2013, and most seniors are expected to stick with the same policies they have already, despite price changes and a rating system that shows some plans may be better than others. Seniors have been reluctant to change plans, even if there are cheaper or better-rated alternatives, according to recent studies and seniors advocates. Beneficiaries also tend to stay with the same insurers: This year more than a third of those in Medicare Advantage plans, which provide medical and drug coverage, chose policies from just two insurers, UnitedHealthcare or Humana.

The ratings are based on information reported by the plans, from Medicare records, and a yearly survey of some beneficiaries. Participation in the surveys is voluntary and anonymous but insurers are concerned that too many seniors opt out. [more]

Enrollment Season Opens For Medicare Advantage And Drug Plans

Link

$18 For A Baby Aspirin? Hospitals Hike Costs For Everyday Drugs For Some Patients

By Susan Jaffe | April 30, 2012 | KAISER HEALTH NEWS produced in collaboration with

For the price Diane Zachor, 66, was charged for one pill to control high pressure during her 18 hour stay at St. Luke’s Hospital In Duluth, Minn., she could have bought a three-week supply. In South Florida, Pearl Beras, 85, of Boca Raton, Fla., said her hospital charged $71 for one blood pressure pill for which her neighborhood pharmacy charges 16 cents. Several other Medicare patients in Missouri were billed $18 for a single baby aspirin, said Ruth Dockins, a senior advocate at the Southeast Missouri Area Agency on Aging.

It’s no mistake: When Medicare patients are in hospitals for observation, they can be charged any amount for routine drugs to treat chronic conditions such as diabetes, high blood pressure or high cholesterol. Medicare doesn’t cover these type of medications and doesn’t require hospitals to tell patients when they are in observation status or that they will be responsible for paying any non-Medicare-covered services.

“I just couldn’t believe some of these prices they charge,” said Zachor (left). “It’s just atrocious.” [More from USA Today or from Kaiser Health News]

Link

By Susan Jaffe

KAISER HEALTH NEWS in partnership wth National Public Radio

DEC 07, 2011

Federal officials are extending the Dec. 7 deadline for three days for some people who have had trouble enrolling in a Medicare prescription drug or private health plan because of the crush of last-minute sign-ups. …Seniors can only get extra time if they get on a call-back list. If they reach a live person, today’s deadline applies and they should be prepared to make a decision…. more

Medicare Offers Extra Enrollment Time For Seniors Who Call Today

Link

By Susan Jaffe November 7, 2011

KAISER HEALTH NEWS in collaboration with

Three weeks after suffering a heart attack, Bernie Hollander came to a recent meeting at Leisure World in Silver Spring with his wife, Rose, to learn about the Medicare drug plans being offered next year. “I’m a heart patient, I’m a diabetic – I have a lot of problems,” said Hollander, 81, who lives in the retirement community. But getting the expensive medications he needs isn’t one of them. e was at the meeting to get updated advice from Leta Blank, head of the Montgomery County Senior Health Insurance Assistance Program (SHIP).

Although drug coverage is optional, millions of Medicare beneficiaries enroll in a plan, and choosing the right one can be tricky. Seniors who want drug coverage must sort through dozens of policies covering different drugs from different pharmacies at different prices. Federal SHIP counselors can help untangle the details. MORE [view video here]

During open enrollment season, seniors can get help picking a Medicare drug plan

Link

By Susan Jaffe | April 26, 2011

KAISER HEALTH NEWS in collaboration with

Despite tough economic times, there are some things the government can’t give away.

Starting this year, seniors enrolled in Medicare no longer have to pay for more than a dozen tests and other services to help prevent or control cancer and other costly and debilitating diseases. These benefits, which also include an annual wellness exam, are part of the new federal health-care law.

But big crowds aren’t lining up for free mammograms or colonoscopies, although early data indicate that the free wellness checkup is luring patients. CONTINUED

Younger, Disabled Medicare Beneficiaries Have Trouble Getting Supplementary Insurance

March 7, 2011

By Susan Jaffe KAISER HEALTH NEWS | March 7, 2011 This story was produced in collaboration with

Joe Hobson, 63, crosses the street in front of his Arlington apartment. (Jessica Marcy / Kaiser Health News).

One night three years ago, Joe Hobson finished reading a book, went to sleep and woke up blind. The problem,a rare hereditary disease, forced him to give up his 20-year communications job, along withits generous health insurance. Now 63, the Arlington man is covered by Medicare, the federal program for elderly and disabled Americans.

Like many people with Medicare, Hobson would like to buy supplemental, or Medigap, insurance to help cover his out-of-pocket costs, such as co-payments and deductibles. But Medigap prices can be prohibitive for disabled beneficiaries younger than 65. The cheapest plan for such people in Northern Virginia is $338 a month, according to Brad Rothermel,an Annandale insurance agent who has helped Hobson look for a policy. That’s three times the premium of a plan with much better benefits that is available to a 65-year-old. And the private insurers that offer Medigap policies are free to reject Hobson or charge him extra because of his preexisting health conditions.[Continued in KHN] andin The Washington Post]

…

Link

By Susan Jaffe | March 22, 2010

KAISER HEALTH NEWS in partnership with

Medication management is coming to nearly 7 million seniors and disabled Americans enrolled in Medicare drug plans. Under new, tougher Medicare rules that took effect in January, private insurers that offer drug coverage must automatically enroll members who have at least $3,000 in total annual drug costs, take several drugs and have chronic health conditions such as diabetes, hypertension or heart disease. MORE

Drug assistance programs keep seniors on track

Link

Consumer guide to prescription drug plans in Northeast Ohio
Susan Jaffe | Plain Dealer Aging Issues Reporter | November 11, 2006

Health insurance companies with contracts from Medicare have been approved to sell a total of 93 plans in Ohio. Some policies cover only drugs, while others include health insurance. This special section provides a consumer guide including the plan basics, some questions to ask before choosing a plan, a translation of the technical jargon companies use, and where to go for assistance.[four-page section here]

Page 2 of 2

« 1 2