Community Options Waiver, Community First Choice (CFC), and Medical Assistance Personal Care (MAPC) programs are three programs that work hand-in-hand to provide community services and support to enable older adults and people with disabilities to live in the community.
Full Answer
What is the Medicare program?
Medicare Program - General Information Medicare is a health insurance program for: People age 65 or older. People under age 65 with certain disabilities.
What are the different types of Medicare plans?
Three prescription drug plans (Part D) are offered (Basic Rx, Premier Rx, and Walmart Value Rx), while wellness and fitness programs are often included in Medigap contracts. Medicare Advantage plans offered include Gold Choice PFFS, Gold Plus Diabetes And Heart C-SNP, Gold Plus HMO, Gold Plus SNP-DE, and Honor PPO.
Will Medicare become a publicly run health plan?
Since the mid-1990s, there have been a number of proposals to change Medicare from a publicly run social insurance program with a defined benefit, for which there is no limit to the government's expenses, into a publicly run health plan program that offers "premium support" for enrollees.
What are the changes to the Medicare and Medicaid EHR incentive programs?
In addition, it changes the Medicare and Medicaid EHR Incentive Programs reporting period in 2015 to a 90-day period aligned with the calendar year. This final rule with comment period also removes reporting requirements on measures that have become redundant, duplicative, or topped out from the Medicare and Medicaid EHR Incentive Programs.
What are the names of the Medicare plans?
Below are the most common types of Medicare Advantage Plans.Health Maintenance Organization (HMO) Plans.Preferred Provider Organization (PPO) Plans.Private Fee-for-Service (PFFS) Plans.Special Needs Plans (SNPs)
What are 4 types of Medicare plans?
There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.
What is the original Medicare plan also called?
En español | Original Medicare, also known as traditional Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it covers.
How many versions of Medicare are there?
There are four parts to Medicare, and each part covers different services. These four types of Medicare are Part A, B, C, and D.
What are the top 3 Medicare Advantage plans?
The Best Medicare Advantage Provider by State Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.
What is Medicare Plan G and F?
Plans F and G are known as Medicare (or Medigap) Supplement plans. They cover the excess charges that Original Medicare does not, such as out-of-pocket costs for hospital and doctor's office care. It's important to note that as of December 31, 2019, Plan F is no longer available for new Medicare enrollees.
Is Original Medicare PPO?
There are several differences in costs and coverage among Original Medicare, Preferred Provider Organizations (PPOs), and Health Maintenance Organizations (HMOs). The table below compares these three types of Medicare plans.
What are the two types of Medicare that are considered traditional?
If you are eligible for Medicare you can chose between getting Medicare benefits through traditional Medicare (also known as original Medicare and traditional Medicare) or a Medicare Advantage (MA) plan.
What is the difference between traditional Medicare and Original Medicare?
Original Medicare covers most medically necessary services and supplies in hospitals, doctors' offices, and other health care facilities. Original Medicare doesn't cover some benefits like eye exams, most dental care, and routine exams.
Which is better PPO or HMO?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
What is the difference between Medicare and Wellcare?
Wellcare offers plans with more coverage than Original Medicare, but without the cost of a Medicare Supplement plan. Our plans also include an extensive network of quality health care providers and some of our plans include prescription drug coverage.
What is the difference between Medicare A and Medicare B?
Medicare Part A and Medicare Part B are two aspects of healthcare coverage the Centers for Medicare & Medicaid Services provide. Part A is hospital coverage, while Part B is more for doctor's visits and other aspects of outpatient medical care.
How many people are in Medicare Advantage in 2015?
In 2015, almost 56 million are enrolled in one or both of Parts A and B of the Medicare program, and almost 18 million of them have chosen to participate in a Medicare Advantage plan.
When did Medicare pay for inpatient hospital care?
1989. The spell of illness and benefit period coverage of laws before 1988 return to the determination of inpatient hospital benefits in 1990 and later. After the deductible is paid in benefit period, Medicare pays 100 percent of covered costs for the first 60 days of inpatient hospital care.
How many days of inpatient hospital care can you use for Medicare?
If a beneficiary exhausts the 90 days of inpatient hospital care available in a benefit period, the beneficiary can elect to use days of Medicare coverage from a nonrenewable “lifetime reserve” of up to 60 (total) additional days of inpatient hospital care. Copayments are also required for such additional days.
How many days are covered by Medicare?
The number of SNF days provided under Medicare is limited to 100 days per benefit period (described later), with a copayment required for days 21 through 100.
What is fee for service in Medicare?
Since the inception of Medicare, fee-for-service claims have been processed by nongovernment organizations or agencies under contract to serve as the fiscal agent between providers and the federal government. These entities apply the Medicare coverage rules to determine appropriate reimbursement amounts and make payments to the providers and suppliers. Their responsibilities also include maintaining records, establishing controls, safeguarding against fraud and abuse, and assisting both providers and beneficiaries as needed.
How long do you have to be on Medicare to receive Part A?
Similarly, individuals who have been entitled to Social Security or Railroad Retirement disability benefits for at least 24 months, and government employees or spouses with Medicare-only coverage who have been disabled for more than 29 months, are entitled to Part A benefits.
What is Medicare Advantage?
Medicare Advantage plans are offered by private companies and organizations and are required to provide at least those services covered by Parts A and B, except hospice services. These plans may (and in certain situations must) provide extra benefits (such as vision or hearing) or reduce cost sharing or premiums.
How many Medicare Advantage plans were there in 2015?
Beneficiaries will be able to choose from 18 Medicare Advantage plans, on average, in 2015, the same number of plans as in 2014. While some plans will leave the market in 2015, others are entering or expanding and most enrollees (over 95 percent) will be able to remain in their same plan in 2015 if they choose.
How much did Medicare pay in 2015?
The average beneficiary who remains in the same Medicare Advantage plan in 2014 and 2015 will pay $41 per month, an increase of $7 per month, or 20 percent, on average; beneficiaries could avoid higher premiums by changing plans or decide that their current plan still is attractive despite the higher premium.
How many people have access to Wellpoint BCBS?
Nearly three out of four beneficiaries nationwide (71%) will have access to a BCBS affiliated plan, including 21 percent who will have with access to a Wellpoint BCBS plan and 58 percent who will have access to plans offered by other companies under the BCBS trademark.
What are the factors that affect Medicare?
People on Medicare have said that many factors are important to them when selecting their plan, including plans’ premiums, cost-sharing, extra benefits, prescription drug coverage, and provider networks. 7 Premiums are the most visible and the easiest of these factors to compare, even though the other factors are also important as they affect beneficiaries’ out-of-pocket costs and access to providers. Medicare beneficiaries enrolled in Medicare Advantage plans pay the Part B premium like other beneficiaries (less any rebate provided by the Medicare Advantage plan). Medicare Advantage enrollees may also pay an additional monthly premium charged by the Medicare Advantage plan for plan benefits and prescription drug coverage. This analysis of premiums includes only Medicare Advantage plans that offer prescription drug coverage (MA-PDs), and excludes the minority of Medicare Advantage plans (14%) that do not cover prescription drugs, in order to better approximate apples-to-apples comparisons across plan types and years.
How many Medicare beneficiaries were there in 2014?
In 2014, more than 16 million Medicare beneficiaries (30%) were enrolled in Medicare Advantage plans – private plans, such as HMOs or preferred provider organization (PPOs) that receive funds from the federal government (Medicare) to provide Medicare-covered benefits to enrollees.
What is the decline in PFFS plans?
To a considerable extent, the decline in plans reflects the diminished role of PFFS plans in the Medicare Advantage marketplace since the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which required most PFFS plans to adopt provider networks.
When did Medicare Advantage get reduced?
Federal payments to Medicare Advantage plans were gradually reduced by the Affordable Care Act of 2010 (ACA) with the goal of creating greater parity in payments between the traditional Medicare program and Medicare Advantage by 2017. 1.
What is Medicare Rights 2015?
As shown above, Medicare Rights’ 2015 helpline data provides a snapshot of the issues that our clients face and provides the template for our policy endeavors. Many of these challenges can be resolved with practical policy solutions, and we make progress in these goals every year. Today’s health care climate, including the threat of ACA repeal without a viable replacement, proposals to cut Medicaid funding, and calls to undo the Medicare guarantee, put recent gains at risk.
Does Ms J have Medicare?
Ms. J has Medicare due to disability and resides in the state of Virginia. She is a retired police officer and receives disability benefits due to an on-the-job injury which continues to cause serious health care issues and pain. She lives on a moderate income that supports herself and two children. Ms. J also has serious issues with bleeding and blood clots. Her doctor felt that surgery to address the bleeding would be dangerous for her. Instead, he wrote a letter to her Medicare Advantage plan requesting the plan authorize and cover a medically necessary procedure to treat her condition. The plan responded in writing, granting prior authorization. Ms J underwent the procedure only to later find that the plan denied coverage, leaving her with a bill for $3,000.
Does Medicare cover Part D?
Medicare Rights continues to receive calls where people with Part D are challenged to afford the cost of their medications during all phases of their Part D coverage. Many callers are unclear as to why prescription drug prices remain costly, and why they cost different amounts across plans. We listen to bewildered, and sometimes angry, beneficiaries about the cost of their prescription drug coverage. People are confused by sometimes wildly fluctuating costs from year to year. Many clients complain that they cannot afford their medications but do not qualify for Extra Help, the federal program that lowers the cost of Part D medications. The Part D coverage gap, also known as the donut hole, is slated to end by 2020 when individuals will pay approximately 25% of the cost of a prescription drug up to the point of catastrophic coverage, when beneficiaries will pay either a 5% coinsurance on the cost of covered drugs or a small copay, whichever is greater.
Do people with Medicare understand their options?
Evidence demonstrates that people with Medicare do not always understand or compare their coverage options. This is true even when year-to-year changes in Medicare Advantage or Part D plan premiums, coverage rules, networks, and cost-sharing make remaining in a given plan less advantageous for beneficiaries. Also, those who are beginning the Medicare enrollment process are faced with numerous choices that can be extremely confusing. Additionally, as evidenced by our helpline trends, people with Medicare Advantage—like Ms. J—can face significant challenges navigating coverage denials and appeals. Medicare Rights supports the following policy reforms to help people with Medicare Advantage make the most of their coverage:
Is Medicare too expensive?
Though Medicare is a life-saving program with many benefits, it can still be too expensive for people with low to moderate incomes. We support the following reforms to improve affordability:
How many people will be on Medicare in 2015?
For 2015, the number of beneficiaries enrolled in Medicare Part D is expected to increase by about 3 percent to 41 million , including about 12 million beneficiaries who receive the lowincome subsidy.
How much did Medicare cost in 2015?
In FY 2015, gross current law spending on Medicare benefits will total $605.9 billion. Medicare will provide health insurance to 55 million individuals who are 65 or older, disabled, or have end-stage renal disease (ESRD).
What is the Medicare Part B deductible?
Modify Part B Deductible for New Enrollees: Beneficiaries who are enrolled in Medicare Part B are required to pay an annual deductible ($147 in calendar year 2014). This deductible helps to share responsibility for payment of Medicare services between Medicare and beneficiaries. To strengthen program financing and encourage beneficiaries to seek high-value health care services, this proposal would apply a $25 increase to the Part B deductible in 2018, 2020, and 2022 respectively for new beneficiaries beginning in 2018. Current beneficiaries or near retirees would not be subject to the revised deductible.
3.4 billion in savings over 10 years]
What percentage of Medicare beneficiaries are covered by Part B?
Part B coverage is voluntary, and about 92 percent of all Medicare beneficiaries are enrolled in Part B. Approximately 25 percent of Part B costs are financed by beneficiary premiums, with the remaining 75 percent covered by general revenues.
How many ACOs are there in the ACO model?
Advance Payment ACO Model: With 35 ACOs currently participating, this initiative, sponsored by the CMS Innovation Center, tests whether prepaying a portion of future shared savings could increase participation in the Medicare Shared Savings Program.
What is Medicare Shared Savings Program?
Medicare Shared Savings Program (MSSP): This initiative is a feeforservice program established by the Affordable Care Act designed to improve beneficiary outcomes and increase value of care. ACOs that meet certain quality objectives and reduce overall expenditures get to share in the savings with Medicare and may also be subject to losses. Since the first cohort of ACOs entered the program in 2012, 343 MSSP ACOs have been established. In the first year of the program, Medicare ACOs generated interim shared savings totaling $128 million for the Medicare trust fund. Fiftyfour ACOs had lower expenditures than projected, and 29 will share interim savings.
What is the Medicare sequestration for 2023?
Modifications to Medicare sequestration for fiscal year 2023 : The Bipartisan Budget Act of 2013 extended the sequestration of Medicare provider payments along with the sequestration of other non-exempt mandatory programs through FY 2023. An additional provision in the Pathway for SGR Reform Act of 2013 accelerates FY 2023 savings from sequestration by applying a higher percentage Medicare reduction to the first six months. (Savings: $2.1 billion from acceleration of Medicare spending reductions in FY 2023)
What age does Medicare cover?
Medicare is a health insurance program for: People age 65 or older . People under age 65 with certain disabilities. People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
What does Medicare Part A cover?
Medicare Part A (Hospital Insurance) - Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.
How many people have Medicare?
In 2018, according to the 2019 Medicare Trustees Report, Medicare provided health insurance for over 59.9 million individuals —more than 52 million people aged 65 and older and about 8 million younger people.
How much does Medicare cost in 2020?
In 2020, US federal government spending on Medicare was $776.2 billion.
What is the CMS?
The Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS), administers Medicare, Medicaid, the Children's Health Insurance Program (CHIP), the Clinical Laboratory Improvement Amendments (CLIA), and parts of the Affordable Care Act (ACA) ("Obamacare"). Along with the Departments of Labor and Treasury, the CMS also implements the insurance reform provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and most aspects of the Patient Protection and Affordable Care Act of 2010 as amended. The Social Security Administration (SSA) is responsible for determining Medicare eligibility, eligibility for and payment of Extra Help/Low Income Subsidy payments related to Parts C and D of Medicare, and collecting most premium payments for the Medicare program.
What is Medicare and Medicaid?
Medicare is a national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, ...
How is Medicare funded?
Medicare is funded by a combination of a specific payroll tax, beneficiary premiums, and surtaxes from beneficiaries, co-pays and deductibles, and general U.S. Treasury revenue. Medicare is divided into four Parts: A, B, C and D.
When did Medicare Part D start?
Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D, which covers mostly self-administered drugs. It was made possible by the passage of the Medicare Modernization Act of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or public Part C health plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by various sponsors including charities, integrated health delivery systems, unions and health insurance companies; almost all these sponsors in turn use pharmacy benefit managers in the same way as they are used by sponsors of health insurance for those not on Medicare. Unlike Original Medicare (Part A and B), Part D coverage is not standardized (though it is highly regulated by the Centers for Medicare and Medicaid Services). Plans choose which drugs they wish to cover (but must cover at least two drugs in 148 different categories and cover all or "substantially all" drugs in the following protected classes of drugs: anti-cancer; anti-psychotic; anti-convulsant, anti-depressants, immuno-suppressant, and HIV and AIDS drugs). The plans can also specify with CMS approval at what level (or tier) they wish to cover it, and are encouraged to use step therapy. Some drugs are excluded from coverage altogether and Part D plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.
When did Medicare+Choice become Medicare Advantage?
These Part C plans were initially known in 1997 as "Medicare+Choice". As of the Medicare Modernization Act of 2003, most "Medicare+Choice" plans were re-branded as " Medicare Advantage " (MA) plans (though MA is a government term and might not even be "visible" to the Part C health plan beneficiary).
Where to send comments to Medicare?
You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3310 & 3311-FC, P.O. Box 8013, Baltimore, MD 21244-1850 .
When did the EHR incentive program begin?
When the Medicare and Medicaid EHR Incentive Programs began in 2011, the requirements for the objectives and measures of meaningful use were designed to begin a process of health care delivery system transformation aligning with foundational goals defined in the Health Information Technology for Economic and Clinical Health Act (HITECH) Act. The HITECH Act requires the Secretary to seek to improve the use of EHR and health care quality over time by requiring more stringent measures of meaningful use (see section 1848 (o) (2) (A) (iii) of the Act); requiring the use of EHR technology, which defines both the functions that should be available within the EHR and the purpose to which those functions should be applied (see section 1848 (o) (4) of the Act); and defining key foundational principles of meaningful use to support the improvement of care and care coordination, and the use of EHR technology to submit information on clinical quality measures and other measures (see section 1848 (o) (2) (A) of the Act).
When will MACRA end?
The enactment of MACRA has altered the EHR Incentive Programs such that the existing Medicare payment adjustment for EPs under 1848 (a) (7) (A) of the Act will end in CY 2018 and be incorporated under MIPS beginning in CY 2019. It is our intent to issue a notice of proposed rulemaking for MIPS by mid-2016. This final rule with comment period synchronizes reporting under the EHR Incentive Programs to end the separate stages of meaningful use, which we believe will prepare Medicare EPs for the transition to MIPS.
What is the 80 FR 20357)?
We proposed ( 80 FR 20357) several alternate exclusions and specifications for providers scheduled to demonstrate Stage 1 of meaningful use in 2015 that would allow these providers to continue to demonstrate meaningful use, despite the proposals to use only the Stage 2 objectives and measures identified for meaningful use in 2015 through 2017. These provisions fall into the following two major categories:
When is the open enrollment period for Medicare?
Senior Medigap plans are not eligible for federal subsidies and have a separate Open Enrollment period (October 15-December 7). When applicants reach age 65 and are Medicare-eligible, a separate enrollment period is created. When you first become eligible, a 7-month enrollment period is available for Parts A and B signup. By waiting until the month you reach age 65 to sign up, Part B benefits may be delayed. There is no law or obligation that requires any person to elect Medicare Supplement coverage.
Where are health insurance plans provided?
Most of the individual and group healthcare plans are provided in Pennsylvania, West Virginia, and Delaware.
What is the cost of SilverScript Smart Rx?
SilverScript Smart Rx is the least expensive option with preferred generic, generic, and preferred brand drug copays of $0, $19, and $46.
How many people are covered by UnitedHealthcare?
UnitedHealthcare. UnitedHealthcare is the insurance wing of UnitedHealth Group, the largest writer of coverage in the US. Currently, more than 70 million persons are covered and the provider network consists of more than 750,000 physicians, specialists and other related professionals.
What happens when you purchase benefits during open enrollment?
When purchasing benefits during Open Enrollment, your pre-existing conditions are covered without paying a higher premium, or waiting for any benefits to begin . Your eligibility for a federal subsidy will determine how much your rate reduces and which cost-sharing features will apply.
What are the factors that determine a healthcare provider's ranking?
Several of the factors used in determining rankings include size, stability, ratings, promptness of paying claims, plan availability, competitiveness of prices, ease of customer service and broker assistance, online enrollment process, and size of local and national provider networks. In recent years, the number of available providers has dwindled, so having access to physicians, hospitals, and other medical facilities is more important than in past years.
Which insurance companies have stopped writing exchanges?
Also, many carriers, such as UnitedHealthcare, Humana, and Aetna, have ceased writing Exchange business. Although they offer Medicare (Supplement, Advantage, and Part D) and Group plans, Marketplace options from these carriers are not available.
Overview
- Title XVIII of the Social Security Act, designated “Health Insurance for the Aged and Disabled,” is commonly known as Medicare. As part of the Social Security Amendments of 1965, the Medicare legislation established a health insurance program for aged persons to complement the retirement, survivors, and disability insurance benefits under Title IIo...
Entitlement and Coverage
- Part A is generally provided automatically and free of premiums to persons aged 65 or older who are eligible for Social Security or Railroad Retirement benefits, whether they have claimed these monthly cash benefits or not. Also, workers and their spouses with a sufficient period of Medicare-only coverage in federal, state, or local government employment are eligible beginnin…
Program Financing, Beneficiary Liabilities, and Payments to Providers
- All financial operations for Medicare are handled through two trust funds, one for Hospital Insurance (HI, Part A) and one for Supplementary Medical Insurance (SMI, Parts B and D). These trust funds, which are special accounts in the U.S.Treasury, are credited with all receipts and charged with all expenditures for benefits and administrative costs. The trust funds cannot be u…
Claims Processing
- Since the inception of Medicare, fee-for-service claims have been processed by nongovernment organizations or agencies under contract to serve as the fiscal agent between providers and the federal government. These entities apply the Medicare coverage rules to determine appropriate reimbursement amounts and make payments to the providers and suppliers. Their responsibiliti…
Administration
- HHS has the overall responsibility for administration of the Medicare program. Within HHS, responsibility for administering Medicare rests with CMS. The Social Security Administration (SSA) assists, however, by initially determining an individual's Medicare entitlement, by withholding Part B premiums from the Social Security benefit checks of most beneficiaries, and …
Medicare Financial Status
- Medicare is the largest health care insurance program—and the second-largest social insurance program—in the United States. Medicare is also complex, and it faces a number of financial challenges in both the short term and the long term. These challenges include: 1. The solvency of the HItrust fund, which fails the Medicare Board of Trustees' test of short-range financial adequa…
Data Summary
- The Medicare program covers most of our nation's aged population, as well as many people who receive Social Security disability benefits. In 2014, Part A covered over 53 million enrollees with benefit payments of $264.9 billion, Part B covered over 49 million enrollees with benefit payments of $261.9 billion, and Part D covered over 40 million enrollees with benefit payments of $77.7 bill…
Medicare: History of Provisions
- This section is a summary of selected Medicare provisions, based on general interest, as of November 1, 2014. It should be used only as a broad overview of the history of the provisions of the Medicare program. This section does not render any legal, accounting, or other professional advice and is not intended to explain fully all the provisions and exclusions of the relevant laws, r…
Plan Offerings in 2015
Plan Premiums
- People on Medicare have said that many factors are important to them when selecting their plan, including plans’ premiums, cost-sharing, extra benefits, prescription drug coverage, and provider networks.7Premiums are the most visible and the easiest of these factors to compare, even though the other factors are also important as they affect beneficiaries’ out-of-pocket costs and …
Plan Availability and Premiums by Firm
- While many organizations offer Medicare Advantage plans, a handful of firms and affiliates account for the majority of all Medicare Advantage enrollment in 2014.11We examine trends among and across these firms and affiliates that account for large shares of Medicare Advantage enrollment nationally: UnitedHealthcare, Humana, Blue Cross and Blue Shield (BCBS) affiliated c…
Limits on Out-Of-Pocket Spending
- The traditional Medicare program does not include a limit on out-of-pocket spending for services covered under Parts A and B, which is one reason most beneficiaries have supplemental coverage to limit their financial liability. Historically, Medicare HMOs provided beneficiaries with an alternative way to obtain comprehensive coverage and early (circa 1980s) plans had relatively li…
Prescription Drug Coverage
- Traditional Medicare did not offer an outpatient prescription drug benefit prior to 2006, and Medicare Advantage plans were an important source of prescription drug coverage for Medicare beneficiaries. While many plans offered some coverage for prescription drugs prior to 2006, beginning in 2006, all beneficiaries had access to a prescription drug plan, either through free-st…
Quality Ratings
- For many years, the CMS has posted quality ratings of Medicare Advantage plans to provide Medicare beneficiaries with additional information about plans offered in their area. All Medicare Advantage plans are rated on a 1 to 5 star scale, with 1 star representing poor performance, 3 stars representing average performance, and 5 stars representing excellent performance. The q…
Discussion
- Medicare beneficiaries will continue to be able to choose from numerous Medicare Advantage plans and 95 percent of beneficiaries enrolled in Medicare Advantage in 2014 will be able to stay with the same plan unless they choose to switch to another. Markets are by nature unstable as they transition in response to competition. Over the past several years, the Medicare Advantage …