Under the Medicare Advantage (MA) quality bonus payment program, initiated in 2012, MA plans with relatively high quality performance that are located in “double bonus”–eligible counties—metropolitan areas with high MA enrollment and low fee-for-service Medicare spending—receive quality bonuses twice as large as those received by equivalently high-quality plans in double-bonus-ineligible counties.
What does double bonus mean?
Double Bonus is a Singaporean Chinese drama which was telecasted on Singapore's free-to-air channel, MediaCorp Channel 8.
How much do Medicare Advantage providers spend on bonuses?
UnitedHealthcare and Humana, which together account for 46% of Medicare Advantage enrollment, have bonus payments of $5.3 billion (46% of total bonus payments) in 2021. BCBS affiliates (including Anthem BCBS) and CVS Health each have $1.6 billion in bonus spending, followed by Kaiser Permanente ($1.1 billion), Cigna and Centene ($0.2 billion each).
What is the Medicare Administrative Contractor bonus?
Some points to remember include the following: Medicare Administrative Contractors (MACs) will base the bonus on the amount actually paid (not the Medicare approved payment amount for each service) and the ten-percent bonus will be paid on a quarterly basis. The HPSA bonus pertains only to physician's professional services.
What is the bonus for a new plan?
New plans (offered by an organization which has not had an MA contract in the three preceding years and thus do not have a sufficient amount of data upon which to qualify) are awarded a 3.5 percent bonus. Contracts in counties with certain demographic factors receive double bonuses. [10]
What is a double quality bonus?
Under the Medicare Advantage (MA) quality bonus payment program, initiated in 2012, MA plans with relatively high quality performance that are located in “double bonus”–eligible counties—metropolitan areas with high MA enrollment and low fee-for-service Medicare spending—receive quality bonuses twice as large as those ...
Can you have 2 Medicare Advantage plans at the same time?
No one is allowed to be enrolled in more than one Medicare Advantage plan at a time. If you have submitted enrollment to two or more Medicare Advantage plans, it is important to determine which plan you wish to be enrolled in.
What is a Medicare supplemental benefit?
A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. These benefits do not need to be provided by Medicare providers or at Medicare-certified facilities. Instead, to receive these items or services, you need to follow your plan's rules.
What are the Medicare 5 star measures?
Medicare has many categories, around 37, actually, for measuring the quality and performance a plan must meet before it can receive a 5-Star Rating. Measures include staying healthy programs, managing chronic conditions, member experience and satisfaction, pharmacy services, and customer service.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
Which two Medicare plans Cannot be enrolled together?
You generally cannot enroll in both a Medicare Advantage plan and a Medigap plan at the same time.
What is the Medicare Part B premium for 2021?
$148.50Medicare Part B Premium and Deductible The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.
How much are Medicare premiums for 2021?
The standard monthly premium for Medicare Part B enrollees will be $148.50 for 2021, an increase of $3.90 from $144.60 in 2020. The annual deductible for all Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from the annual deductible of $198 in 2020.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
What is the highest rated Medicare Advantage plan?
Best Medicare Advantage Plans: Aetna Aetna Medicare Advantage plans are number one on our list. Aetna is one of the largest health insurance carriers in the world. They have an AM Best A-rating. There are multiple plan types, like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).
What is the Best Medicare plan D for 2022?
The 5 Best Medicare Part D Providers for 2022Best in Ease of Use: Humana.Best in Broad Information: Blue Cross Blue Shield.Best for Simplicity: Aetna.Best in Number of Medications Covered: Cigna.Best in Education: AARP.
Who is the largest Medicare Advantage provider?
UnitedHealthcareUnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly three-quarters of U.S. counties.
Why do doctors not like Medicare Advantage Plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
Does getting a Medicare Advantage plan make you lose original Medicare?
If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Can you have Mapd and stand alone PDP?
Some Medicare Advantage Plans allow you to choose your own standalone Medicare Part D Prescription Drug plans, while others include a predetermined plan. You cannot have a standalone Medicare Part D plan if your Medicare Advantage plan already includes prescription coverage.
Is Part D included in Medicare Advantage?
Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan's medical and prescription drug coverage.
Background
Roughly one-third of all Medicare beneficiaries are enrolled in the Medicare Advantage program under which private health insurers assume the responsibility for, and the financial risk of, providing Medicare benefits.
Option
This option consists of two different alternatives. The first alternative would eliminate benchmark increases that are tied to quality scores starting in 2021. The second alternative would eliminate double bonuses from Medicare Advantage benchmarks.
Effects on the Budget
Implementing either of the two alternatives would reduce mandatory spending between 2021 and 2028, according to estimates by the Congressional Budget Office. CBO projects that the first alternative—eliminating benchmark increases on the basis of quality bonuses—would reduce mandatory spending by $94 billion between 2021 and 2028.
Other Effects
An advantage of the first alternative is that it would address some of the criticisms of quality bonuses that are highlighted above. Specifically, reducing Medicare's spending on payments to plans would reduce the degree to which Part B premiums paid by Medicare FFS beneficiaries financed supplemental benefits for Medicare Advantage enrollees.
Research Objective
Enrollment in Medicare Advantage (MA) – private plans for Medicare beneficiaries – has grown remarkably. Fueled by generous Medicare payments, MA offers attractive benefits and modest cost-sharing. Yet policymakers have argued that MA plans are overpaid and questioned its value.
Study Design
We used national data to test the association of double bonuses with MA enrollment, quality and equity from 2008 through 2018. First, using difference-in-differences (DID) analysis of enrollment in MA vs traditional Medicare, we compared MA enrollment in double-bonus and non-double-bonus counties, before and after double bonus eligibility.
Population Studied
We evaluated MA enrollment using the 100% Medicare Beneficiary Summary File (544,356,215 beneficiary-years). We evaluated MA quality using 100% claims data for MA beneficiaries ages 50–74 using the largest commercial MA database in the United States (27,249,714 measure-beneficiary-years).
Principal Findings
In the pre-period (2008–2011), MA enrollment was 36% and 18% in double-bonus versus non-double-bonus counties, respectively. In DID models, double bonuses were not associated with changes in MA enrollment (DID, −1.9 percentage point [pp], 95% confidence interval [CI], −4.1, 0.3).
Conclusions
In this national study of the MA double bonus policy, we report three main findings. First, double bonuses were not associated with MA enrollment. Second, double bonuses were not associated with MA quality performance. Finally, double bonuses were offered much less frequently to plans serving Black than White populations.
Implications for Policy or Practice
Our findings suggest that double bonuses are not an efficient or equitable mechanism for promoting enrollment or quality in MA. As MA expands, CMS should experiment with alternative strategies for improving value and equity in the program.
How much is the bonus for Medicare 2021?
UnitedHealthcare and Humana, which together account for 46% of Medicare Advantage enrollment, have bonus payments of $5.3 billion (46% of total bonus payments) in 2021. BCBS affiliates (including Anthem BCBS) and CVS Health each have $1.6 billion in bonus spending, followed by Kaiser Permanente ($1.1 billion), Cigna and Centene ($0.2 billion each).
What percentage of Medicare Advantage plans will receive bonus payments in 2021?
In 2021, 81 percent of all Medicare Advantage enrollees are in plans that receive a bonus payment from Medicare based on star quality ratings (or because they are new), substantially higher than the share in 2015 (55 percent). Annual bonus payments from the federal government to Medicare Advantage insurers have increased correspondingly, ...
How much is Medicare Advantage rebate in 2021?
Additionally, as more enrollees are in plans that are in bonus status, the average rebate per Medicare Advantage enrollee has more than doubled, rising from $184 per year in 2015 to $446 per year in 2021.
Why are bonus payments increasing?
The rise in bonus payments is due to both an increase in the number of plans receiving bonuses, and an increase in the number of enrollees in these plans. Because unrated plans also receive bonus payments, a total of 85 percent of enrollees are in plans that are eligible to receive quality bonus payments, and 81 percent ...
How much is the average bonus for 2021?
The average bonus per enrollee in an employer plan is $886 in 2021, more than 2.5 times higher than for enrollees in either individual plans ($351) or SNPs ($309). While average bonuses in employer plans have consistently been higher than for other plans, the gap has increased substantially in recent years, driven by a rapid rise in the average bonuses for employer plans. Both the high share of enrollees in group plans that receive bonus payments (98% in 2021), as well as changes to the payment methodology for group plans implemented starting in 2017 contribute to this trend.
What is Medicare Advantage 2021?
Medicare Advantage in 2021: Star Ratings and Bonuses. Medicare Advantage plans receive a star rating based on performance measures that are intended to help potential enrollees compare plans available in their area as well as encourage plans to compete based on quality. All plans that are part of a single Medicare Advantage contract are combined ...
Why do Medicare Advantage plans get stars?
Medicare Advantage plans receive a star rating based on performance measures that are intended to help potential enrollees compare plans available in their area as well as encourage plans to compete based on quality. All plans that are part of a single Medicare Advantage contract are combined when calculating the quality rating ...
Introduction
For years, policymakers and health insurers have looked for ways to simultaneously reduce federal health care expenditures and ensure better quality care for patients.
How Stars are Calculated
The 5-star rating system was first implemented by CMS for MA plans in 2008 serving as a tool to inform beneficiaries as to the quality of the various plan options and assist them in the plan selection process. Ratings are set at the MAO contract level—not the plan level—meaning all plans under the same contract receive the same score.
How Rewards are Calculated
Under a provision of the Affordable Care Act (ACA), these star ratings began to be used to adjust payments to MAOs beginning in 2012. Bonuses were to be awarded for contracts receiving 4 or more stars.
Results Thus Far
In 2012, 91 percent of MA contracts received a bonus payment, but only 4 percent of the total bonus payments came from funds designated for these bonuses by the ACA—the rest of the bonuses were paid through the demonstration project which allowed for bonuses to be paid to 3-star plans.
Effective Tool for Patients?
While it is likely that the star ratings have been a somewhat useful tool for beneficiaries in differentiating between otherwise similar plans, it seems that individual preferences do not exactly line up with the criteria CMS has decided to use in evaluating MA plans under the Star Rating System.
Adverse Impact on the Poor
Many have expressed concern that the Star Rating System—because of how measures are evaluated and rewards are paid—unfairly punishes both low-income enrollees and the plan sponsors primarily serving such enrollees.
Poor Program Structure Creates Misaligned Incentives and Unintended Consequences
The Star Rating System has had other unintended consequences resulting from poor program structure and misaligned incentives. Some of the biggest problems with the program structure relate to timing.
What is the HPSA bonus?
The HPSA bonus pertains only to physician's professional services.
When did modifiers stop being included in HPSA?
Effective January 1, 2005, a modifier no longer has to be included on claims to receive the HPSA bonus payment, which will be paid automatically, if services are provided in ZIP code areas that either:
When was the Medicare Advantage rule released?
CMS followed up with the release of the final rule, Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the Program for All-inclusive Care for the Elderly (PACE) on Friday, April 6, 2018.
When will CMS expand supplemental benefits?
In recognition of provisions of the Bipartisan Budget Act of 2018 (BBA), CMS also notes changes that expand supplemental benefit offerings for beneficiaries with chronic illnesses starting in the 2020 plan year. CMS states that future rulemaking may allow for greater benefit flexibility in response to these changes.
What is the CMS final rule?
In the final rule, CMS finalized a reinterpretation of statutory language to allow supplemental benefits that compensate for physical impairments, reduce the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.
What is QPP in Medicare?
The Medicare Access and CHIP Reauthorization Act (MACRA) instituted a Quality Payment Program (QPP), under which clinicians participating in Medicare generally will be paid under the Merit-based Incentive System (MIPS) or as a qualifying participant (QP) in Advanced Alternative Payment Models (AAPMs).
What is a V-BID plan?
The MA Value-based Insurance Design Model (V-BID) offers supplemental benefits or reduced cost sharing to enrollees with certain chronic conditions. CMS will expand the model in 2019 to begin allowing plans to submit V-BID proposals for the following states:
Does CMS require multiple bids?
CMS will eliminate the requirement that permits MAOs to submit multiple bids for the same area only if the plans substantially different from one another based on key plan characteristics such as premiums, cost sharing, or benefits offered. The proposed rule stated that the policy is intended to foster greater “competition, innovation, available benefit offerings, and provide beneficiaries with affordable plans that are tailored for their unique health care needs and financial situation.”
When are CMS bids due?
The policies outlined in the proposed rule would apply to contract year 2019, for which bids are due to CMS by June 4, 2018. Select key provisions of the call letter and final rule are highlighted below.
