Today’s Hot Topics in Medicare News

Medicare changes could have some patients paying more for drugs

BY LISA RAPAPORT: A proposed shift in Medicare coverage for medicines administered by doctors may help reduce total drug spending, but a new study suggests it may also lead to higher out-of-pocket costs for some patients.

Right now, drugs given by infusion or injection in outpatient settings like doctors’ offices are covered by Medicare Part B, which is part of the original Medicare program. In a push to curb health spending, the Trump administration has proposed moving coverage for many of these physician-administered medicines to standalone drug plans known as Medicare Part D, which typically contract with pharmacies to fill prescriptions for consumers. (read more)

Supreme Court justices lean toward hospitals in Medicare DSH case

BY SUSANNAH LUTHI: Two U.S. Supreme Court justices on Tuesday pushed back on the federal government’s sweeping Medicare payment change cutting billions of dollars from hospitals, saying the procedure for the formula change didn’t reflect the magnitude of the policy’s impact.

In oral arguments before eight of the justices, Sonia Sotomayor and Neal Gorsuch both focused on how hospitals would be hit by the CMS’ alterations to its Medicare disproportionate share hospital payment formula in 2014. The change was put into place without a public notice-and-comment period, which several hospitals claim violates federal law. (read more)

OPINION: Keep your Medicare costs down

BY GREG DILL: Most doctors accept Medicare as full payment for their services. But some accept it only for certain services, and others don’t accept it at all.

What does this mean for you?

If you have Original Medicare, it means you should try to use doctors, hospitals, medical equipment suppliers, and other healthcare providers that participate or “accept assignment” in Medicare. Such providers have signed agreements to take Medicare as payment in full for their services. (read more)

Double-Digit Increase in Medicare Advantage Plan Growth May Be Good News for Seniors but Bad News for Local Clinical Laboratories and Pathology Groups in 2019

BY ANDREA DOWNING PECK: Continuing enrollment growth in Medicare Advantage plans is expected in 2019 and beyond. The projections are for double-digit percentage increases in Medicare Advantage enrollees. This is not auspicious for clinical laboratories and anatomic pathology groups because it means a shrinking proportion of Medicare beneficiaries remain in the Part B program.

Whereas any medical laboratory can provide services for any Medicare Part B beneficiary, that is not true for beneficiaries enrolled in Medicare Advantage plans. That’s because private health insurers operating Medicare Advantage plans typically contract with national lab companies while narrowing their lab networks, thereby limiting access to these patients by independent community laboratories, hospital lab outreach programs, and pathology groups.

Enrollment in Medicare Advantage is expected to reach record totals in 2019. More than 22.6 million new Medicare beneficiaries are anticipated, with 14 new private companies offering plans, Kaiser Health News (KHN) reports. As enrollment shifts from traditional Medicare to Medicare Advantage the health of regional clinical laboratories can suffer, as smaller labs lose access to beneficiaries. (read more)

A “do-over” chance for Medicare open enrollment

BY STEVE VERNON: You probably thought you were finished thinking about Medicare when the 2018 open enrollment period ended on Dec. 7. Not so fast: Medicare has another limited open enrollment that runs from Jan. 1 through March 31, 2019, for Medicare Advantage plans. Here’s a brief review to help you understand your options.

You face a fundamental decision regarding how you receive medical treatment under Medicare:

  • Original Medicare usually gives you the most flexibility to choose your health care providers, but it’s also the most complicated way to receive benefits. It’s recommended that you supplement original Medicare with a Medicare Supplement Plan to help cover Medicare’s substantial deductibles and copayments and that you buy a Part D prescription drug plan to pay for prescription drugs. (read more)

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