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KHN: Researcher: Medicare Advantage Plans Costing Billions More Than They Should

Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found. Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, said his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients. (Schulte, 11/11)

Medicare enrollees who take expensive medicines could save thousands of dollars a year under the Democrats’ sweeping social agenda bill, but those dividends won’t come overnight. Instead, they’ll build gradually over the decade. Unveiled late last week, the bill’s Medicare prescription drug compromise barely survived a pharmaceutical industry lobbying blitz. Experts who’ve analyzed the complex plan say it would also offer people with private insurance some protection from the escalating cost of their medicines. (Alonso-Zaldivar, 11/11)

Medicare’s annual open-enrollment season is here and millions of beneficiaries — prompted by a massive advertising campaign and aided by a detailed federal website — will choose a private Medicare Advantage plan. But those who have instead opted for traditional Medicare face a critical decision about private insurance. Too often the import of that choice is not well communicated. (Meyer, 11/10)

Some older Americans may be all too familiar with sticker shock when it comes to their Medicare premiums. That is, instead of paying the standard premium for Part B (outpatient care coverage) and Part D (prescription drug coverage), their income is high enough for monthly “income-related adjustment amounts,” or IRMAAs, to kick in. However, the surcharge is typically based on their tax return from two years earlier — which may not accurately reflect their current financial situation. (O'Brien, 11/10)

The Centers for Medicare and Medicaid Services is walking back its push to pay for more complex services without inpatient stays, a move that will dent revenues for health systems that have boosted investment in outpatient facilities. The agency announced during the Trump administration that it would phase out its list of around 1,700 services Medicare would only pay for on an inpatient basis due to the complexity of the procedure, the underlying physical condition of the patient or the need for at least 24 hours of postoperative recovery time. CMS began that phase-out in 2021 by removing 298 services from the list. (Kacik and Goldman, 11/10)

More than 12 million people have enrolled in Medicaid and the Children's Health Insurance Program since COVID-19 outbreaks began in the U.S., largely due to shifting eligibility requirements and increases in federal funding to make care more accessible. Now, community health centers are worried these flexibilities might not last once the public health emergency ends, leaving many without insurance. (Devereaux, 11/10)

KHN: Medicare’s Open Enrollment Is Open Season For Scammers

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured by questionable information — that may not cover their drugs or include their doctors. In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers. (Jaffe, 11/11)