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Medicare

One of MACI's goals is to keep seniors, the disabled and the public in general informed and up-to-date on critical governmental proposals and decisions that could or will impact their healthcare benefits, insurance plans or decisions.  Below are some of the most recent Centers for Medicare and Medicaid Services (CMS), Social Security Administration, Medicare and Kaiser Family Foundation news releases and articles that address issues impacting the Medicare Program.  
 

Key Medicare Terms Explained, "Medicare Assisnments" and "Medicare Part B Excess Charges"  

When dealing with Medicare, physicians/providers falls within one of three categories:
        1) 
Physicians/providers who accept Medicare assignments; and
        2) 
Non-participating physicians/providers;
        3) 
Physicians/providers who have formally opted out of Medicare.  Click here to learn more.

Medicare Part B Excess Charges is a term that is used with Medicare Supplement, or Medigap, plans. These charges, most simply defined, are charges that a doctor charges above and beyond the Medicare-approved amount for a service or procedure. Many physicians DO accept the Medicare-approved amount; however, there are some that do NOT. In these cases, you can be responsible for this amount above and beyond the Medicare-approved amount, unless you have a Medicare supplement plan that covers Medicare Part B Excess charges, such as Medigap Plan F or Medicare Supplement Plan G. These plans cover 100% of the Part B Excess charges.  Click here to learn more.

2017 Medicare Costs At A Glance 

Listed in the attached web-linkare figures associated with the basic costs for people with Medicare. If you want to see and compare costs for specific health care plans, visit the Medicare Plan Finder. For specific cost information (like whether you've met your deductible, how much you'll pay for an item or service you got, or the status of a claim, visit MyMedicare.govFind out if Medicare covers a specific test, item or service that's not listed under the detailed Medicare cost information section of this page.  Click here to access web-link.


Facts About Our Medicare Program

Most Medicare beneficaies have questions regarding their benefits, rights and options.  MACI would like to take this opportunity to share with your some of 2015/16 data and figures as they relate to and impact the program's operational coverage and associate costs.  Click here to learn more.  

CMS Releases 2015 National Health Expenditures

In 2015, per-capita health care spending grew by 5.0 percent and overall health spending grew by 5.8 percent, according to a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs. Those annual rates continue to be below the rates of most years prior to passage of the Affordable Care Act. And, even as millions of people gained coverage, per-enrollee spending growth in private health insurance and Medicare continue to be well below the average in the decade before passage of the Affordable Care Act.  Click here to learn more.

Medicare Trustees Report Shows Continued Slow Cost Growth

The Medicare Trustees project that the trust fund financing Medicare’s hospital insurance coverage will remain fully funded until 2028, 11 years longer than they projected in 2009 before the passage of the Affordable Care Act.

“Per-Medicare beneficiary cost growth continues to be exceptionally low,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS). “For more than five decades, Medicare has provided financial security and accessible health care to millions. With growing numbers of Americans relying on Medicare, it’s our job to continue the hard work to strengthen Medicare and the health care system as a whole.”

Per-enrollee Medicare spending growth has been low, averaging 1.4 percent over the last five years, slower than GDP per capita (2.9 percent) and overall health expenditures per capita (3.4 percent). And over the next decade, per-enrollee Medicare spending growth (4.3 percent) is expected to continue to be lower than the growth in overall per capita national health expenditures (4.9 percent). Total Medicare spending is projected at a faster 6.9 percent average annual rate over the next decade, reflecting continued enrollment growth driven by the growth of the over-65 population.  Click here to learn more.

Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018

The Centers for Medicare & Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories.   

In response to public comments, CMS moved implementation of the new payment system from January 1, 2017 to January 1, 2018 to allow laboratories sufficient time to develop the information systems necessary to collect, review, and verify data before reporting applicable information to CMS. This will also allow time for CMS to perform independent validation and testing of the CMS system through which laboratories will report applicable information, and allow laboratories to perform end-to-end testing of their systems with CMS’ system.  Click here to learn more

CMS Announces Proposed Payment Changes for Medicare Home Health Agencies for 2017

The Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2017 that would foster greater efficiency, flexibility, payment accuracy, and improved quality. Approximately 3.4 million beneficiaries received home health services from approximately 11,400 home health agencies, costing Medicare approximately $17.8 billion in 2015.

In the rule, CMS projects that Medicare payments to home health agencies in CY 2017 would be reduced by 1.0 percent, or $180 million based on the proposed policies. The proposed decrease reflects the effects of the 2.3 percent home health payment update percentage ($420 million increase); the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($420 million decrease); the effects of the -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth for an impact of -0.9 percent ($160 million decrease); and the effects of the proposed increase to the fixed-dollar loss (FDL) ratio used in determining outlier payments from 0.45 to 0.56 for an estimate impact of -0.1 percent ($20 million decrease).

To be eligible for the home health benefit, beneficiaries must need intermittent skilled nursing or therapy services and must be homebound and under the care of a physician. Covered home health services include skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, medical social services, and medical supplies. Home Health Agencies (HHAs) are paid a national, standardized 60-day episode payment for all covered home health services, adjusted for case-mix and area wage differences.  Click here to learn more.