While health policy observers are mainly focused on the number of people enrolled in the new federal and state marketplaces, fewer are keeping a close eye on fairly big changes in the estimates and projections for enrollment in Medicare Advantage plans. The number of Medicare beneficiaries in Medicare private plans reached an all-time high this year of nearly 16 million beneficiaries, 6.3 million higher than the Congressional Budget Office (CBO) had projected in 2010 soon after the Affordable Care Act (ACA) was enacted (Figure 1). The CBO now projects Medicare Advantage enrollment will reach 22 million beneficiaries by 2020, more than double the number projected shortly after the ACA was enacted.
The Medicare Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for people on Medicare known as Part D, which went into effect in 2006. All 54 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Medicare drug benefit through private plans approved by the federal government. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. The Affordable Care Act of 2010 (ACA) made some important changes to Part D—in particular, phasing out the coverage gap by 2020.
As the November open enrollment period approaches, consumers in the federal and state marketplaces will soon have the opportunity to renew or change health plans for 2015. Health insurance plans often change from one year to the next, and some of these changes could have a real impact on costs and coverage, including changes in premiums, cost-sharing, benefits, formularies and choice of doctors and hospitals. Consumers are advised to review their options carefully before deciding whether to renew their current plan or enroll in a new one. But will they?
Marsha Gold and Giselle Casillas
While the majority of Medicare beneficiaries still receive their benefits through the traditional Medicare program, 30 percent now obtain them through private health plans participating in Medicare Advantage. As the number of Medicare Advantage enrollees continues to climb, there is growing interest in understanding how the care provided to Medicare beneficiaries in Medicare Advantage plans differs from the care received by beneficiaries in traditional Medicare.
Despite the interest, the last comprehensive review of research evidence on health care access and quality in Medicare Advantage and traditional Medicare is more than 10 years old and did not focus exclusively on Medicare (Miller and Luft 2002). That study found that health maintenance organizations (HMOs) provide care that is roughly comparable in quality to the care provided by non-HMOs (mainly traditional indemnity insurance), and that quality varied across health plans. It also found that HMOs used somewhat fewer hospital and other expensive resources in delivering care, with enrollees rating them worse on many measures of access and satisfaction. However, the market has changed substantially over the last decade, making it important that policymakers have available more current analysis, particularly on Medicare health plans.
This literature review synthesizes the findings of studies that focus specifically on Medicare and have been published between the year 2000 and early 2014. Forty-five studies met the criteria for selection, including 40 that made direct comparisons between Medicare health plans and traditional Medicare. An additional five studies are included, even though they have no traditional Medicare comparison group, because they include a comparison of health care access and quality in different types of Medicare Advantage plans. A full list of the studies included in this analysis is found in the Works Cited.
Holly Dawson believes her job is a calling.
She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.
Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.
George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans’ benefits.
When Dawson worked for him, Grellinger paid an agency $37 for two hours of her time each day. Dawson received $13 an hour, higher than the national average for home health aides. She had to pay her own taxes and health care benefits. Dawson says she can’t remember the last time she could afford health insurance.
Dawson says she has been a home health aide for 31 years. She has never done it for the money, rather to help people like Grellinger, she says.
Starting Dec. 1, people with ALS – a disease that impairs motor function so people often can’t talk or even move – could lose access to technological advances that allow them to better communicate, thanks to a federal review of what Medicare is allowed to cover.
ALS, which stands for amyotrophic lateral sclerosis, hit the national spotlight this summer with the viral “Ice Bucket Challenge.” But while public awareness about the disease soared, Medicare changes that could curtail coverage of communication tools were – by “sheer dumb luck” – already in the works, said Kathleen Holt, associate director at the Center for Medicare Advocacy.
October 27, 2014
A 78-year-old Vermont mother of four who helped change Medicare coverage for millions of other seniors is still fighting to persuade the government to pay for her own care.
Glenda Jimmo, who is legally blind and has a partially amputated leg due to complications from diabetes, was the lead plaintiff in a 2011 class-action lawsuit seeking to broaden Medicare’s criteria for covering physical therapy and other care delivered by skilled professionals. In 2012, the government agreed to settle the case, saying that people cannot be denied coverage solely because they have reached a plateau and are not getting better.
The landmark settlement was a victory for Medicare beneficiaries with chronic conditions and disabilities who had been frequently denied coverage under what is known as “the improvement standard” —a judgment about whether they are likely to improve if they get additional treatment. It also gave seniors a second chance to appeal for coverage if their claims had been denied because they were not improving.
A federal law since the 1990s has prohibited “self-referral,” in which doctors profit from Medicare-reimbursed procedures they order. But many physician groups have found ways to do it anyway, exploiting a loophole to the law in ways its writers didn’t anticipate, reports The Wall Street Journal.
In Louisiana's Senate race, Medicare is grabbing the spotlight. The powerful issue is also popping up in North Carolina and Iowa. Meanwhile, Michigan's Senate race references to Medicare and the health law are checked for accuracy. And Obamacare is the subject of ads in an increasingly high-profile California House contest.
With nearly 50 years of home care experience, we understand how important it is for people to stay in the comfort and security of their homes. But sometimes, the challenges of everyday living get beyond even the most independent-minded person.
When is it necessary to move into an assisted-living facility? Can in-home care help? Are you worried about a loved one living alone? This simple quiz can help you answer the hard questions - and provide you with the first steps to getting extra help or support.
Medicare and You 2014
Coverage & costs change yearly Medicare health plans