Today’s Hot Topics in Medicare

Trump guts Medicare

OPINION: Trump’s next move: After tax cuts, gut Medicare

BY TOM MORAN: By a 2-1 margin, Americans oppose the Republican tax plan and say it favors the rich over the middle-class.

Just wait until the massive spending cuts arrive, and programs like Medicare are squeezed dry to cover the costs of this misadventure.

That’s right. It turns out Congress once gave a damn about the national debt, and established rules to keep it in check. One of those rules — known as “pay-go” –imposes automatic and immediate cuts when Congress passes legislation that would increase the debt.

Which programs would be cut? The Congressional Budget Office just put out its list, and the big loser would be Medicare, which would be cut by $25 billion this year, and by larger sums each year for a decade. Students loans would take a hit as well, as would spending on border security and Obamacare. (read more)

Medicare Advantage, Part D updates to shift control to health plans

BY THOMAS BEATON: CMS is proposing regulatory changes that would offer health plans additional flexibility to design and implement Medicare Advantage (MA) and Part D Medicare benefits.

The rule would reduce administrative burdens by allowing plans to communicate with beneficiaries electronically. The proposals would also remove health plan requirements to send duplicate administrative information to CMS and lessen marketing restrictions on payers offering these plans.

Health plans would be allowed to increase out-of-pocket spending limits for MA beneficiaries, provide generic drugs and cheaper biosimilars in Part D plans, and adjust cost-sharing and deductible amounts based on medical criteria. (read more)

Time is running out to lock in your Medicare coverage

BY SARAH O’BRIEN: Medicare recipients who haven’t yet re-evaluated their coverage have about two weeks left to make changes.

The program’s open enrollment period, which started Oct. 15, ends on Dec. 7. This seven-week window is generally the only time you can make changes to your Advantage Plan (Medicare Part C) or prescription drug coverage (Part D). And with premiums for Part B (outpatient care) jumping by 23 percent for many Medicare beneficiaries, trying to contain costs in other areas is crucial. (read more)

Medicare home health payments to drop by $80 million under final 2018 rule

BY REED SMITH: The final CMS calendar year (CY) 2018 Medicare home health prospective payment system (HH PPS) rule cuts Medicare payments by 0.4% ($80 million) in 2018 compared to 2017 levels, but CMS did not adopt a more sweeping case mix methodology reform proposal that would have reduced 2019 payments by almost $1 billion.

Under the final rule, CMS applied a 1% update percentage as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) for those home health agencies (HHAs) that report required quality data (otherwise the update is decreased by 2 percentage points). This positive update was more than offset by other rate adjustments, however, including a 0.5% reduction due to the sunset of the rural add-on provision and a 0.9% reduction for nominal case-mix coding intensity growth (the last year of a three-year phase in period). The final CY 2018 national, standardized 60-day episode payment rate is $3,039.64, compared to $2,989.97 for 2017; the rate for an HHA that does not submit required quality data is $2,979.45. (read more)

42% of Medicare beneficiaries will see their Part B premiums rise by 23% in 2018

BY SEAN WILLIAMS: The fourth quarter is an important time of the year for senior citizens. It’s when they find out what, if any, raise they’ll be receiving from Social Security, as well as how much extra, if any, they’ll owe in monthly premiums to Medicare.

Though the two programs might seem to be independent of one another, they’re linked at the hip in some respects. In fact, because of a Medicare quirk known as “hold harmless,” around 70% of seniors may not see much, or any, of their Social Security cost-of-living adjustment (COLA) in the upcoming year. (read more)

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