Posts Tagged ‘Medicare’

Rising healthcare industry brings stand-alone tail coverage to mind

March 19, 2015 Leave a comment

money_healthWhile technology, energy and other industry sectors often capture the headlines in the financial press and in the media, health care companies are a major economic force within the U.S. economy and growing. According to The World Bank, health care spending between 2010 and 2014 accounted for nearly 18% of U.S. GDP. This number is only expected to grow in the decade ahead. While some have argued that the PPACA will slow this trend, I find little evidence that it will do so in any meaningful fashion. All of this means that health care dollars spent in the U.S. will claim an increasing portion of our GDP. Read more…

Working through the Medicare and ACA information overload

September 16, 2013 Leave a comment

Confusion is abundant in the Medicare world due to the Affordable Care Act. Advertising for state exchanges, media coverage about employers moving their retirees to private exchanges and Medicare Open Enrollment all overlapping have resulted in much confusion for Medicare beneficiaries.

Both national and regional carriers are offering plans to both Medicare beneficiaries and to the non-Medicare population on the exchange platforms. In years past, only Medicare eligible plans have been advertised in the fall. With the new state exchanges launching their open enrollment on October 1st for under 65ers, advertising has commenced for a wide variety of plans. Medicare beneficiaries are not eligible for these plans, but this distinction is not evident to many Medicare consumers. In addition to that, IBM and other mega-employers have been in the press Read more…

New Medicare payment data offers pricing transparency for patients

medicare2Last week, CMS released hospital charges and the corresponding Medicare payments for the 100 most common diagnostic codes at more than 3,000 hospitals nationwide. This database has received quite a bit of press, but what does it really show us? In Massachusetts, we have 56 hospitals represented. Of these hospitals, it shows how many patients received the procedure, what the average price billed was to the government and what Medicare actually paid. For those of us not accessing Medicare coverage,  it may seem like data just for the sake of data, but in fact it can be quite useful to anyone accessing care at these facilities.

While a hospital may not actually receive the amount they are charging and your private insurance may not pay the amount that Medicare pays, it gives everyone a ballpark of how different facilities Read more…

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Presidential election puts Medicare back in the spotlight

October 11, 2012 Leave a comment

Medicare is a prominent topic in the 2012 Presidential election and in last week’s debate it was in the forefront on primetime television. How did Medicare get such a coveted position?

The first reason is the Baby Boomer vote. More than 72 million Baby Boomers will be 65, or Medicare reliant by 2030. In the 2008 presidential election year, there were 169 million registered voters. Based on these statistics, Baby Boomers make up a significant percentage of the voting base for the 2012 Presidential election and they’re concerned about retirement and healthcare after retirement.

After we’ve determined that an influential and large population has a vested interest in the topic of Medicare, we come upon the second reason that Medicare has become such a controversial Read more…

Three steps for human resources when it comes to retirement medical guidance

September 6, 2012 Leave a comment

Retirement brings uncertainty. Most Americans, throughout their careers, have relied on their employers and specifically Human Resource professionals to provide guidance, advocacy and support in most of their benefits decisions. Employer sponsored benefits and retirement programs are the cornerstone of protecting our health and long-term financial security. But in retirement, choosing a medical plan, a pharmacy program, or a place to park your 401k dollars is a scary proposition for even the most informed consumer.

Although most companies have done away with group sponsored retiree medical plans, it does not preclude them from becoming an information center for prospective retirees. Employees (or parents of employees) approaching age 65 are often inundated with information on Medicare, Medicare Supplements, Part D Read more…

RACs are here to stay…

While ambiguity remains about the future path of healthcare in America, it seems certain that CMS will intensify the effort to collect improper Medicare/Medicaid payments from healthcare providers. The “Tax Relief and Health Care Act of 2006” created the Medicare RAC (Recovery Audit Contractor) program. Four recovery audit contractors administer the program in their respective region of the country. These contractors operate as private entities and are paid on a contingency fee basis – receiving a percentage of the improper overpayments they collect from providers (between 9-12 percent of any overpayments). CMS reports collecting over $1.27 billion in overpayments since October 2009.

The recouping of over one billion dollars to an already financially strained Medicare/Medicaid program has not gone unnoticed by CMS. PPACA (Patient Protection and Affordable Care Act of 2010) ushered in a new wave of RACs, most notably by creating the Medicaid RAC program and Read more…

GAO reports on the Medicare Advantage bonus program

The non-partisan Government Accountability Office (GAO) released their findings on the interim Medicare Advantage (MA) bonus program last week. This interim bonus program was put into place to help quell the uproar from the initial Medicare Advantage cuts that were initiated with PPACA and is set to run from 2012 to 2014. It was found that the estimated $8.35B program will not improve quality for MA programs due to the distribution of bonuses to plans rated with 3 or 3.5 stars (out of 5). While this program does reward plans rated with 4 and 5 stars, it does not incent lower rated plans to improve their quality. It is estimated that the majority of spend with the MA Quality Bonus Payment Demonstration will be paid to these plans that are rated with 3 and 3.5 stars. Under the PPACA plan roughly 30% of all MA plan sponsors would be eligible for bonus in 2012 and 2013. With the Read more…