In sum, for Medicare beneficiaries, health care reform means no cuts to Medicare’s guaranteed benefits; some benefit improvements; and an extension of Medicare Part A’s Trust Fund to 2029. Below is a more detailed overview of some of the major changes affecting Medicare and its beneficiaries. Part D Coverage Gap Rebate (2010)
Full Answer
What are the pros and cons of health care reform?
· Reforms to Medicare should honor and maintain its core values to ensure its continued success for future generations. As stated by Nancy-Ann DeParle, a former Administrator of the Health Care Financing Administration (HCFA, now CMS): Few programs in the history of the United States have brought as much benefit to society as Medicare.
What would Medicaid reform mean for You?
· Overview: The Centers for Medicare & Medicaid Services (CMS) is taking its first step in launching the Medicare contracting reforms mandated by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA). This important new effort will improve the operation of the Original Medicare program affecting both beneficiaries and the …
What are the changes in Medicare?
· The health reform legislation eliminates out-of-pocket cost-sharing for most Medicare-covered preventive and screening services. It also establishes an Annual Wellness Visit. This visit will: Be covered every 12 months, starting 12 months after the Welcome to Medicare Exam Have no cost-sharing (and no cost-sharing for the Welcome Exam)
What is the best health plan for Medicare?
· The Medicare spending reduction called for in the health reform bill is the rough equivalent of raising the age of eligibility for 65-year-olds …
What are some reforms of Medicare?
8 Medicare and Medicaid reforms that would have the biggest impact on federal spendingEstablish caps on federal spending for Medicaid. ... Reduce federal Medicaid matching grants. ... Change the cost-sharing rules for Medicare and restrict Medigap insurance. ... Increase the premiums for Parts B and D of Medicare.More items...
How should Medicare be reformed?
Congress should reform Medicare graduate medical education payments by converting the payments into direct grants to institutions sponsoring residency training programs; allowing ambulatory care settings such as physician groups to receive funding for sponsoring residencies; and cutting the total amount of spending by ...
Why is it necessary to reform Medicare?
Why reform Medicare? The main reason for reforming Medicare is not that the program is the principal driver of future federal spending increases, although it is. The main reason is not that Medicare beneficiaries could be receiving much better coordinated and more effective care, although they could.
When was Medicare last reformed?
Medicare policy under the Obama Administration (2009-2017) Former President Barack Obama signed the Affordable Care Act (ACA) into law on March 23, 2010—establishing what would become one of the longest lasting legacies of his two terms in office.
What does the future of Medicare look like?
After a 9 percent increase from 2021 to 2022, enrollment in the Medicare Advantage (MA) program is expected to surpass 50 percent of the eligible Medicare population within the next year. At its current rate of growth, MA is on track to reach 69 percent of the Medicare population by the end of 2030.
What share of Medicare spending comes from the Medicare tax?
Medicare is funded primarily from general revenues (43 percent), payroll taxes (36 percent), and beneficiary premiums (15 percent) (Figure 7). Part A is financed primarily through a 2.9 percent tax on earnings paid by employers and employees (1.45 percent each) (accounting for 88 percent of Part A revenue).
What legislation has been enacted to ensure the quality of healthcare for Medicare eligible beneficiaries?
Barack Obama signs the Affordable Care Act (ACA), which strengthens Medicare coverage of preventive care, reduces beneficiary liability for prescription drug costs, institutes reforms of many payment and delivery systems, and creates the Center for Medicare and Medicaid Innovation.
What is global budget in healthcare?
Global budgets are an alternative payment model (specifically, a form of capitation) in which providers—typically hospitals—are paid a prospectively-set, fixed amount for the total number of services they provide during a given period of time.
Which president changed Medicare?
President George W. Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act of 2003, adding an optional prescription drug benefit known as Part D, which is provided only by private insurers.
What did the Medicare Modernization Act do?
The 2003 Medicare Modernization Act (MMA) is considered one of the biggest overhauls of the Medicare program. It established prescription drug coverage and the modern Medicare Advantage program, among other provisions. It also created premium adjustments for low-income and wealthy beneficiaries.
What is the difference between Medicare and Medicaid?
Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.
When did Medicare start?
Since its inception in 1965, the Medicare program has been required to contract with health insurance companies to perform its claims processing and related administrative functions. Over the ensuing 40 years, the contracting portion of Medicare’s fee-for-service administrative structure has not been modernized to keep up with changes in healthcare ...
When was Medicare Modernization Act enacted?
These improvements, mandated by the Medicare Modernization Act (MMA), were outlined in a Report to Congress released by the Secretary of Health and Human Services on February 7, 2005.
What is the income related monthly adjustment amount for Medicare?
Currently, an individual beneficiary with an income of >$85,000 pays more. The threshold of $85,000 will be frozen between 2011 and 2019 and will not be adjusted for inflation. This means that more people will reach the threshold and pay a higher amount for their Part B premium. Also, effective January 1, 2011, people with higher incomes ($85,000/individual and $170,000/couple) will also have to pay a higher portion of their Part D premium under the same formula.
How much does Medicare cover for generic drugs?
In 2011, Medicare will begin its gradual phase-in of a subsidy for generic drugs, starting with a 7% subsidy of the generic drug costs. By 2020, enrollees will pay only 25% of their generic drug costs and the subsidy will cover the other 75%.
Why are LIS beneficiaries reassigned to Part D?
This is because their former plan’s premium would be higher than the benchmark amount for the new year, and the LIS covers the full Part D premium for plans who charge amounts less than or equal to the benchmark amount. (The term ‘ benchmark amount ’ refers to a weighted average premium in a region for a given year. In California, the benchmark amount is $28.99 for 2010. Part D plans with premiums below the benchmark amount are called benchmark plans..#N#This fall, LIS beneficiaries are less likely to be reassigned to Part D plans for 2011 because:
When did Medicare start phasing in?
In 2011, the law froze the benchmark amount at 2010 levels for the maximum amount paid for MA plans in each county. Then, in 2012, the government began phasing in payment reductions to Medicare Advantage in an effort to bring Medicare Advantage spending in line with the fee-for-service program (Original Medicare), although benchmark amounts could also increase based on plan quality.
What did reform supporters say about Obamacare?
During the debate, reform critics warned that the ailing Medicare system would be further weakened by government efforts to restructure it. Reform supporters countered that although the program was critical to millions of Medicare-eligible Americans, it could not continue without dramatic restructuring.
What is Medicare D subsidy?
When Medicare D was created, it included a provision to provide a subsidy to employers who continued to offer prescription drug coverage to their retirees, as long as the drug covered was at least as good as Medicare D. The subsidy amounts to 28 percent of what the employer spends on retiree drug costs.
How much will Medicare Part B cost in 2021?
In 2021, most Medicare Part B enrollees pay $148.50/month in premiums. But beneficiaries with higher incomes pay additional amounts – up to $504.90 for those with the highest incomes (individuals with income above $500,000, and couples above $750,000). Medicare D premiums are also higher for enrollees with higher incomes.
How did the ACA reduce Medicare costs?
Cost savings through Medicare Advantage. The ACA gradually reduced costs by restructuring payments to Medicare Advantage, based on the fact that the government was spending more money per enrollee for Medicare Advantage than for Original Medicare. But implementing the cuts has been a bit of an uphill battle.
Why did Medicare enrollment drop?
When the ACA was enacted, there were expectations that Medicare Advantage enrollment would drop because the payment cuts would trigger benefit reductions and premium increases that would drive enrollees away from Medicare Advantage plans.
What percentage of Medicare donut holes are paid?
The issue was addressed immediately by the ACA, which began phasing in coverage adjustments to ensure that enrollees will pay only 25 percent of “donut hole” expenses by 2020, compared to 100 percent in 2010 and before.
How many fewer readmissions for Medicare?
This translates to about 130,000 fewer readmissions for Medicare beneficiaries. Additionally, as part of a new Affordable Care Act initiative, clinicians at some hospitals have reduced their early elective deliveries to close to zero, meaning fewer at-risk newborns and fewer admissions to the NICU.
What is the Affordable Care Act?
The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and building on the health information technology infrastructure that enables new payment and delivery models to work. These reforms and investments will build a health care system that will ensure quality care for generations to come.
What is EHR in healthcare?
• Electronic Health Records (EHRs). Adoption of electronic health records continues to increase among physicians, hospitals, and others serving Medicare and Medicaid beneficiaries helping to evaluate patients’ medical status, coordinate care, eliminate redundant procedures, and provide high-quality care. More than 62 percent of health care professionals, and over 86 percent of hospitals, have already qualified for EHR incentive payments for using certified EHR technology to meet the objectives and measures established by the program, known as meaningful use. Electronic health records will help speed the adoption of many other delivery system reforms, by making it easier for hospitals and doctors to better coordinate care and achieve improvements in quality.
How many ACOs are there in Medicare?
Over 360 organizations are participating in the Medicare ACOs, serving approximately 5.3 million Medicare beneficiaries. As existing ACOs choose to add providers and more organizations join the program, participation in ACOs is expected to grow. Medicare ACOs participating in the Shared Savings Program generated $128 million in net savings for the Medicare trust fund to date.
How many Medicare Advantage plans were there in 2014?
In 2014, the 14.6 million Medicare beneficiaries currently enrolled in Medicare Advantage have access to 1,625 five and four-star plans, which is 473 more high-quality plans than were available in the previous year. Below are specific examples of the reforms and investments that we are making to build a health care delivery system ...
How many stars did Medicare Advantage get in 2014?
Over one-third of Medicare Advantage contracts received four or more stars in 2014, which is an increase from 28 percent in 2013. Over half of Medicare Advantage enrollees are enrolled in plans with four or more stars in 2014, a significant increase from 37 percent of enrollees in 2013.
What is the slowing of premium growth?
Slowing private premium cost growth by over 60 percent means real savings for workers, their families, and employers. The Affordable Care Act’s 80 / 20 rule (medical loss ratio policy) has led to estimated savings of $5 billion over the past two years.