eHealth, Inc.’s Post

The Centers for Medicare & Medicaid Services (CMS) released the final Part 2 guidance for the Medicare Prescription Payment Plan (M3P) program in mid-July. Alongside the guidance, CMS issued revised M3P model documents incorporating public feedback. Here's a breakdown of the revised documents and some key changes: https://hubs.ly/Q02JdTLv0

💵 Explained: How Medicare Advantage Plans Are Paid Privately run #MedicareAdvantage plans now enroll about half of all Medicare beneficiaries. As enrollment continues to grow, how they are paid — and how much — will be central to the debate over the efficiency and sustainability of #Medicare spending. A new Commonwealth Fund explainer breaks down how the Centers for Medicare & Medicaid Services, which oversees #Medicare, determines payment rates to help ensure plans can meet patients’ health needs while making efficient use of taxpayer dollars. Payments are adjusted up or down each year, using federal government benchmarks and a risk adjustment model based on enrollees’ expected health costs. It's a complicated process, and sometimes a controversial one. In our explainer, you’ll learn: 📊 how county-level payment benchmarks are set ⚠️ how the risk adjustment process is updated 💰 how plans submit bids for covering enrollee health costs, and much more.

Good to see this RFI from Centers for Medicare & Medicaid Services. More sunshine about what tax payers and people enrolled in Medicare Advantage actually get can and should lead to reporting and quality improvements. https://lnkd.in/eAwikVw5 #medicareadvantage

The finalized 2025 MA rates are more than just a component of the wider healthcare regulatory framework; they are strategic imperatives that require a diligent, collaborative, and innovative response from health insurance professionals. By understanding the nuanced implications and strategically addressing the changes, healthcare organizations stand to harness these rates as a platform for sustained growth, improved care quality, and operational excellence.

The American Hospital Association and the Federation of American Hospitals recently commented on the growing consensus among hospital trade groups that Medicare Advantage insurers are skirting around new federal regulations that aim to improve patient healthcare access. This alleged circumvention of new policies follows the April final rule by Centers for Medicare & Medicaid Services that now requires Medicare Advantage plans to cover the same services as fee-for-service Medicare. Read more in Modern Healthcare.

I expect so much more of this. Seniors are getting priced out of Medicare and denied the services they need because of these cuts. As I’ve stated before when we have the current inflation, state of the economy and Increasing comorbidities agencies rejections of referrals are already high they will increase even more with cuts. We have to find a better way to deliver more cost effective care and at the same time deliver liveable wages to our Nurses, Caregivers and staff. Ultimately the seniors are suffering from lack of providers acceptance due to low to no profit margins a lot of referrals are begining to be taken at a loss basically. At a time when we need increases a highly suggest we revert some of this over seas money to combat Senior care issues, mental health and homelessness… But what do I know I’m Just a Nurse and CEO who cares about his patients and staff 🤷🏽♂️🤷🏽♂️🤷🏽♂️ As usually we shall figure this out! 😊

An excellent article by Wendell Potter with Healthcare Uncovered regarding the Medicare landscape. A few key comments below from the article 👇. "Over the past few days, both CVS/Aetna and Humana admitted to Wall Street that their Medicare Advantage plans are not nearly as profitable as those insurers had predicted a year ago. As a consequence, hundreds of thousands – and probably millions – of seniors and disabled people enrolled in Aetna’s and Humana’s plans may soon wish they had never heard of Medicare Advantage. Sadly, most will find they’re trapped in a circle of hell created by the insurance industry, unable to stay in their current Medicare Advantage plan but also unable to return to traditional Medicare because of what for them will be unaffordable Medicare supplemental policies (most of which are sold by the same big insurers that sell MA plans). Seniors have six months from the date they’re eligible for Medicare to buy a supplemental (Medigap) policy to cover out-of-pocket expenses. If they’ve been enrolled in an MA plan longer than six months, they’ll have to go through medical underwriting. That means that if they’re being treated for much of anything or, God forbid, have a “preexisting condition,” they’ll have to pay an arm and a leg for Medigap policy. Yet another big Medicare Advantage player, Centene, says it, too, will be cutting thousands of its enrollees adrift as it exits counties in six states. Nearly 40,000 seniors and disabled people will be affected. #medicare #medicareadvantage #seniors #disabled #consumers #patients #insurers #volatile #profits #losses #brokers #advisors #agents

The recent announcement of the 2025 Medicare Advantage (MA) rates by the Centers for Medicare & Medicaid Services (CMS) is a crucial roadmap that outlines a year ahead under a complex funding mechanism. This article caters is for those looking to understand the deep-seated implications of these rates and to strategize proficiently come 2025.

While we have Medicare clients in nearly all 50 states, the biggest disruption in the Medicare disrupting the country this year is here in San Diego County. While we have the lowest % of #medicareadvantage business and the highest % of #medicaresupplement plans in our peer group of 700 agencies, I don’t think it’s helpful to conclude that Medicare Advantage plans are bad. It’s the insurers’ behavior that appears to be the issue. The insurers get paid by Medicare. The recently passed Omnibus Bill just cut provider fees by 2% (POTUS wanted a 4% cut). You’ve gotta look upstream. If they want single payer healthcare upstream, then they need to squeeze everyone downstream. ALL that said, as a #financialadvisor, I would NEVER suggest aligning with a Medicare partner who doesn’t FULLY explain BOTH Advantage AND Supplement plans . Most Medicare agents sell 90-100% Medicare Advantage plans. Costs the clients less. Pays the agent more. The result of clients going through our agnostic #medicareexecutionprocess under the watchful eye of the advisor is typically 60% Medicare Supplement and 40% Medicare Advantage, to the detriment of our revenue. That is JUST fine with us so long as the client understands BOTH options, AND the entire experience reflects well on the advisor. #whatsyourmedicareexecutionprocess