Category Archives: Medicare

Medicare proposes expansion of counseling program for people at risk of diabetes

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GlucometerBy Mary Agnes Carey
Kaiser Health News

As the health law turned six Wednesday, federal officials proposed the expansion of a Medicare diabetes prevention program funded by the landmark measure.

The pilot program, developed and administered by the YMCA, helped Medicare enrollees at high risk of developing the disease improve their diets, increase their exercise and lose about 5 percent of their body weight.

Beneficiaries in the program, funded by an $11.8 million grant provided by the health law, attended weekly meetings with a lifestyle coach to develop long-term changes to their diet, discussed ways to get more physical activity and made behavior changes that would help control their weight and decrease their risk of Type 2 diabetes. Participants could also attend monthly follow-up meetings to help keep their new habits in place.

Compared to other beneficiaries also at risk of developing diabetes, Medicare estimated savings of $2,650 for each program enrollee over a 15-month period, more than enough to cover the cost of the program, according to the Department of Health and Human Services. Continue reading

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Coinsurance trend means seniors likely to face higher out-of-pocket drugs costs, report says

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By Michelle Andrews
Kaiser Health News

Medicare beneficiaries may get dinged with higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee, a new analysis found.

Fifty-eight percent of covered drugs in Part D drug plans are subject to “coinsurance” in 2016 rather than flat copayments, the analysis by Avalere Health found. The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs.

For beneficiaries, drug plans’ increasing use of coinsurance may mean higher out-of-pocket costs, among other things. If a drug costs $200, instead of making a flat $20 copayment, they may owe 20 percent of the cost, or $40. Continue reading

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Long-term care insurance: Less ban, more buck

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Mary Julia Klimenko, 69, in her office in Benicia, Calif., on Friday January 29, 2016. The therapist invested in a long-term care insurance policy, but her monthly premiums have nearly quadrupled over the past two years. Klimenko is furious with the choices she’s been given: pay the higher cost, reduce her costs by cutting her policy’s benefits, or drop the insurance altogether. (Heidi de Marco/KHN)

Mary Julia Klimenko, 69, in her office in Benicia, Calif., on Friday January 29, 2016. The therapist invested in a long-term care insurance policy, but her monthly premiums have nearly quadrupled over the past two years. Klimenko is furious with the choices she’s been given: pay the higher cost, reduce her costs by cutting her policy’s benefits, or drop the insurance altogether. (Heidi de Marco/KHN)

By Barbara Feder Ostrov
Kaiser Health news

Mary Julia Klimenko thought she was prudent 20 years ago when she invested in a long-term care insurance policy, one she believed would help pay for the care she’d need as she aged.

Now she wishes she’d banked the money instead.

Her monthly premiums have nearly quadrupled over the past two years, and Klimenko, now 69, is furious about the choices she’s been given: pay the higher cost, lower her premiums by cutting her policy’s benefits or drop the insurance altogether.

I have no choice. If I drop my insurance, I’ve thrown away all that money. If I pay less, they’re not going to cover what I need.

For now, the Vallejo, California therapist said she will pay the higher premiums, but she’s not sure how many more price hikes she can take.

“I have no choice. If I drop my insurance, I’ve thrown away all that money,” Klimenko said. “If I pay less, they’re not going to cover what I need.”

Long-term care insurance was supposed to help the middle class ease the financial burden of expensive in-home or nursing home care that now can top $90,000 a year.

Consumers were urged to buy policies in their 50s, because premiums rose the longer they waited. About 4.8 million people were covered by long-term care policies in 2014.

But insurers botched just about every aspect of the policies they sold in the early days of the industry, said Joseph Belth, a retired professor of insurance at Indiana University known as one of the insurance industry’s toughest critics.

They underestimated how long people would live and how long they’d need nursing home care — but overestimated how many people would drop their policies and how much interest insurers could earn on the premiums they banked.

Hemorrhaging money, many insurers left the business. Those that remain are in financial trouble on their long-term care policies. They’re charging far more for new policies, and sharply raising the premiums of old ones.

“The industry is a state of severe decline,” Belth said. “Companies … don’t see a way to successfully market the product and make money on it.” Continue reading

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Medicare plans score higher ratings and millions in bonuses

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Rayne Lowder, a nurse practitioner for Vantage Health Plan, talks with a Vantage Medicare patient at a clinic in West Monroe, Louisiana. (Courtesy Vantage Health Plan)

Rayne Lowder, a nurse practitioner for Vantage Health Plan, talks with a Vantage Medicare patient at a clinic in West Monroe, Louisiana. (Courtesy Vantage Health Plan)

By Phil Galewitz
Kaiser Health News

Vantage Health Plan executives saw an opportunity when they realized few of their female Medicare members were being screened for osteoporosis after they broke bones.

The test to identify women at increased risk for fractures is one of 40 measures that Medicare applies to produce its 5-star ratings comparing the private plans chosen by nearly a third of seniors over traditional coverage.

More than $3 billion is in play for insurers. Health plans earning at least four stars qualify for federal bonus payments. Those that don’t, lose out.

To improve its score, Vantage last year bought a $10,000 mobile ultrasound unit so it could give bone density screenings to its elderly women members in their homes. The proportion of eligible women tested soared from 13 percent in 2014 to 71 percent in 2015.

“The ten grand we spent on the ultrasound machine was more than worthwhile,” said Billy Justice, director of marketing and sales for Vantage, an insurer with 16,000 Medicare members in Louisiana.

Here’s why: Vantage lifted its overall star rating to 4 stars from 3.5 and set itself up for as much as $8 million in extra federal funding next year. By law, the bonus money must go to pay for extra benefits, which helps plans attract more members and in turn makes them more profitable. Continue reading

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Insurers and Medicare agree on measures tracking doctors’ quality

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By Jordan Rau
KHN

The federal government and the insurance industry released on Tuesday an initial set of measures of physician performance that they hope will reduce the glut of conflicting metrics doctors now must report.

doctorqualityratings

The measures are intended to make it easier for Medicare, patients, insurers and employers to assess quality and determine pay. Continue reading

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Slipping between Medicaid and marketplace coverage can leave consumers confused

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Shopping CartBy Michelle Andrews
KHN

For people whose income changes shift them above or below the Medicaid threshold during the year, navigating their health insurance coverage can be confusing.

Ditto for lower income people who live in states that may expand Medicaid this year.

Under the health law, states can expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (about $16,000 for an individual). Thirty states and the District of Columbia have done so.

This week I answered three questions from readers about how Medicaid interacts with plans on the health insurance marketplaces.

Q. In my state, if my income drops below 138 percent of the federal poverty level, I have to drop my marketplace plan and sign up for Medicaid. But if my income increases and I become eligible for a marketplace plan again, what happens to any payments I’ve made toward the deductible and out-of-pocket maximum for that plan? Do they reset to zero so I have to start all over again? Continue reading

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Feds fund effort to tie medical services to social needs

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Young woman holds an older woman's handBy Julie Rovner
KHN

The federal government has announced a $157 million project to help hospitals and doctors link Medicare and Medicaid patients to needed social services that sometimes have a bigger impact on their health than medical interventions.

Public health experts have known for decades that even with medical care easily available, patients are often limited in their ability to get better or maintain good health if they lack stable housing, access to healthy food, or the ability to get to and from medical appointments.

The goal of the project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities.

The goal of the “Accountable Health Communities” project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities.

The social services to be linked include those related to housing, food, personal safety, inability to pay utility bills and transportation. The project will fund up to 44 separate experiments over five years.

Applications are being accepted by the Centers for Medicare & Medicaid Services and announcement of the winning proposals is expected later this year. Continue reading

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Medicare payment changes lead more men to get colonoscopies

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Illustration of the colon from Gray's AnatomyBy Michelle Andrews
KHN

Medicare Payment Changes Lead More Men To Get Screening Colonoscopies

Men are getting more screening colonoscopies since the health law reduced how much Medicare beneficiaries pay out of pocket for the preventive tests, a recent study found. The change, however, didn’t affect women’s rates.

, published in the December issue of Health Affairs, compared rates of screening for colorectal cancer among people age 66 to 75 before and after the health law passed in 2010.

Starting in 2011, that law waived the Medicare Part B deductible (which totals $147 annually in 2015) and eliminated the requirement that beneficiaries pay 20 percent of the cost for screening colonoscopies.

The study found that in men, colonoscopy screening rates increased from 18 to 22 percent following implementation of the health law, a 20 percent increase.

The data came from the Centers for Disease Control and Prevention’s annual Behavioral Risk Factor Surveillance System.

The study found that in men, colonoscopy screening rates increased from 18 to 22 percent following implementation of the health law, a 20 percent increase. In women, however, the rate didn’t budge, remaining at 18 percent even after the law passed. Continue reading

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Report: Home care workers need better job protections

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A younger man's hand holding the hand of an elderly manBy Anna Gorman
KHN

A lack of oversight in the rapidly growing home care workforce could undermine new wage and labor gains for many of the nation’s 2 million workers, according to a report released Monday.

Private agencies employ the vast majority of home care workers, who provide services that are largely paid for by Medicare, Medicaid and other federal and state programs. But the companies are poorly regulated, which could hamper the enforcement of new labor standards, said the National Employment Law Project (NELP), a labor advocacy group.

Home care workers this year gained federal minimum wage and overtime protections after a lengthy battle in the federal courts. The U.S. Department of Labor is expected to begin full enforcement in 2016.

To ensure that workers can take advantage of the new benefits, stronger oversight of the industry is needed, said Sarah Leberstein, one of the report’s authors. Continue reading

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Baby boomers set another trend: More golden years in poorer health

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240px-Peace_sign.svgBy Lisa Gillespie
KHN

After the last of the baby boomers become fully eligible for Medicare, the federal health program can expect significantly higher costs in 2030 both because of the high number of beneficiaries and because many are expected to be significantly less healthy than previous generations.

The typical Medicare beneficiary who is 65 or older in 2030 will more likely be obese, disabled and suffering from chronic conditions.

such as heart disease and high blood pressure than those in 2010The typical Medicare beneficiary who is 65 or older then will more likely be obese, disabled and suffering from chronic conditions such as heart disease and high blood pressure than those in 2010, according to a report by the University for Southern California’s Schaeffer Center of Health Policy and Economics. Continue reading

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Fewer Medicare-subsidized drug plans means less choice for low-income seniors

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Denise Scott, 66, is concerned about how much Medicare will pay for her prescriptions in the future.

Denise Scott, 66, is concerned about how much Medicare will pay for her prescriptions in the future.

By Susan Jaffe
KHN

Even though health problems forced Denise Scott to retire several years ago, she feels “very blessed” because her medicine is still relatively inexpensive and a subsidy for low-income Medicare beneficiaries covers the full cost of her monthly drug plan premiums. But the subsidy is not going to stretch as far next year.

That’s because the premium for Scott’s current plan will cost more than her federal subsidy.

The 64-year-old from Cleveland is among the 2 million older or disabled Americans who will have to find new coverage that accepts the subsidy as full premium payment or else pay for the shortfall.

As beneficiaries explore options during the current Medicare enrollment period, there are only 227 such plans from which they can choose next year, 20 percent fewer than this year, and the lowest number since the drug benefit was added to Medicare in 2006, according to the Centers for Medicare & Medicaid Services. Continue reading

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Humana to offer telehealth coverage through some Medicare Advantage plans

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humana new logoThe health insurance company Humana will begin covering telehealth consultations through some of its 2016 Medicare Advantage plans in Washington state.

The telehealth benefit, which will will be provided in partnership with the telehealth company MDLIVE, will be offered through the Humana Community HMO plans available in the King and Spokane counties and the Humana Gold Plus plans available in Benton, Franklin and Pierce counties.

Service will provide members of those plans 24/7 access to doctors through personal computers, telephone or mobile devices for less severe medical issues, such as cold and flu, headaches and skin infections.

“Video and telephone visits allow our members to receive health care when and where they need it,” said Catherine Field, Intermountain Vice President for Humana’s Senior Products.

People with Medicare may select these plans during the annual Medicare enrollment period, which runs Oct. 15 through Dec. 7, 2015. Those selecting a plan with this option will be able to start using the benefit Jan. 1, 2016.

Washington state Medicare beneficiaries living in King, Spokane, Benton, Franklin and Pierce counties who are interested in utilizing MDLIVE should visit www.Humana-Medicare.com<http://www.Humana-Medicare.com> to search these plans and learn more about this and other plan benefits.

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Questions about Medicare’s annual open enrollment? Washington state’s SHIBA can help!

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CalendarFrom the Office of the Insurance Commissioner

It’s not too soon to start thinking about Medicare’s open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans.  Open enrollment takes place every year, Oct. 15 through Dec. 7.

The Statewide Health Insurance Benefits Advisors (SHIBA) offers free help to people with Medicare questions.

Before you make your decision, consider the following tips:  Continue reading

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Seniors who don’t consider switching drug plans may face steep price rise

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By Michelle Addrews
KHN

When Mildred Fine received the annual notice informing her about changes to her Medicare prescription drug plan for 2016, she was shocked. If she stayed with the same plan, her monthly premium would more than triple, from $33.90 to $121.10, and her annual deductible would rise from $320 to $360.

“People just have to check their plans every year to see what’s going on.”

The increase didn’t make sense to Fine, 84, whose prescriptions haven’t changed and whose drugs are generally inexpensive. She takes two generic blood pressure drugs and a generic antidepressant, as well as Estrace, an estrogen cream. This year, she didn’t meet her deductible until September.

Working with a counselor from her local State Health Insurance Assistance Program, Fine logged on to Medicare’s plan finder to compare the roughly 20 plans available near her home in Burns, Ore.

She found a plan with no deductible and a monthly premium of $33.50, less than what she pays now. Fine estimates she’ll save nearly $1,500 next year in out-of-pocket costs compared with what she would have paid if she’d stuck with her current plan.

“People just have to check their plans every year to see what’s going on,” Fine says.

But most Medicare beneficiaries don’t do that, studies show. Continue reading

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Medicare spending for hepatitis C cures surges

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Twenty-dollar bill in a pill bottleBy Charles Ornstein ProPublica
This story was co-published with The Washington Post.

Medicare’s prescription drug program spent nearly $4.6 billion in the first half of this year on expensive new cures for the liver disease hepatitis C 2014 almost as much as it spent for all of 2014.

Medicare’s drug program spent an eye-popping $4.8 billion for hepatitis C drugs in 2014.

Rebates from pharmaceutical companies 2014 the amounts of which are confidential 2014 will reduce Medicare’s final tab for the drugs, by up to half. Even so, the program’s spending will likely continue to rise, in part because of strong demand.

Medicare’s stunning outlays, spelled out in data requested from the government by ProPublica, raise troubling questions about how the taxpayer-funded program can afford not only these pricey medications, but a slew of others coming on the market. Continue reading

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