“Medicare Advantage enrollment has steadily increased both nationally and within most states since 2005, with more than 40 percent of Medicare beneficiaries enrolled in Medicare Advantage plans in 2021. The share of Medicare Advantage enrollees varies across the country: in 26 states and Puerto Rico, at least 40 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2021, and at least 50 percent in Florida, Minnesota and Puerto Rico. In a growing number of counties, more than half of all Medicare beneficiaries are in a Medicare Advantage plan, in lieu of traditional Medicare. Enrollment continues to be highly concentrated among a handful of firms, both nationally and in local markets, with UnitedHealthcare and Humana together accounting for 45 percent of enrollment in 2021.”
“The private plans known as Medicare Advantage now cover more than 4 in 10 Medicare beneficiaries, reflecting a more than doubling of enrollment over the past decade even as the plans remain a far larger presence in some states than others, according to a new KFF analysis.
“More than 26 million of the nation’s nearly 63 million Medicare beneficiaries are enrolled in Medicare Advantage plans in 2021. The share varies considerably by state, ranging from less than 20 percent in Vermont, Maryland, Alaska, and Wyoming, to more than 50 percent in Minnesota, Florida, and Puerto Rico, the analysis finds.
“Enrollment rates also vary widely across counties, within states. In Florida, for example, it ranges from 16 percent in Monroe County (Key West) to 73 percent in Miami-Dade County. Nationally, 29 percent of Medicare beneficiaries live in a county where more than half of all Medicare beneficiaries are enrolled in Medicare Advantage plans.
‘The new analysis is one of three released by KFF today that examine various aspects of Medicare Advantage, a type of Medicare coverage that the Congressional Budget Office has projected will cover 51 percent of all Medicare beneficiaries by 2030.
“One brief provides current information about Medicare Advantage enrollment, including the types of plans in which Medicare beneficiaries are enrolled, and how enrollment varies across geographic areas. A second analysis describes Medicare Advantage premiums, out-of-pocket limits, cost sharing, extra benefits offered, and prior authorization requirements. A third compares Medicare Advantage plans’ star ratings and federal spending under the quality bonus program.
“Among other key findings: Continue reading →
Device Makers Have Funneled Billions to Orthopedic Surgeons Who Use Their Products – Kaiser Health News
Dr. Kingsley R. Chin was little more than a decade out of Harvard Medical School when sales of his spine surgical implants took off.
Chin has patented more than 40 pieces of such hardware, including doughnut-shaped plastic cages, titanium screws and other products used to repair spines — generating $100 million for his company SpineFrontier, according to government officials.
Yet SpineFrontier’s success arose not from the quality of its goods, these officials say, but because it paid kickbacks to surgeons who agreed to implant the highly profitable devices in hundreds of patients.
In March 2020, the Department of Justice accused Chin and SpineFrontier of illegally funneling more than $8 million to nearly three dozen spine surgeons through “sham consulting fees” that paid them handsomely for doing little or no work. Chin had no comment on the civil suit, one of more than a dozen he has faced as a spine surgeon and businessman. Chin and SpineFrontier have yet to file a response in court.
Medical industry payments to orthopedists and neurosurgeons who operate on the spine have risen sharply, despite government accusations that some of these transactions may violate federal anti-kickback laws, drive up health care spending and put patients at risk of serious harm, a KHN investigation has found. These payments come in various forms, from royalties for helping to design implants to speakers’ fees for promoting devices at medical meetings to stock holdings in exchange for consulting work, according to government data.
Health policy experts and regulators have focused for decades on pharmaceutical companies’ payments to doctors — which research has shown can influence which drugs they prescribe. But far less is known about the impact of similar payments from device companies to surgeons. A drug can readily be stopped if deemed harmful, while surgical devices are permanently implanted in the body and often replace native bone that has been removed. Continue reading →
by Rodney A. Brooks
“After a lifetime of racial and health inequities, Black seniors are at risk of spending their last years with declining health, little income and virtually no savings.
“Numerous studies have noted that Black Americans have worse health than their white counterparts, including chronic diseases and disabilities leading to shorter and sicker lives than white Americans. A recent 2016 CIGNA Health Disparities report found:
- Four in 10 Black men aged 20 or older have high blood pressure, a rate 30 percent higher than that of white men. Black men’s risk of a stroke is twice that of white men. For Black women, 45 percent of those aged 20 and older have high blood pressure, a rate 60 percent higher than white women.
- Black women are 40 percent more likely to die of breast cancer than white women.
- Black men have a 40 percent higher cancer death rate than white men.
- Black Americans are 80 percent more likely to be diagnosed with diabetes than whites, and nearly twice as likely to be hospitalized.
- Blacks are more than twice as likely as whites to suffer from Alzheimer’s and other kinds of dementia.
“Black women, said Tyson Brown, associate professor of sociology at Duke University, suffer from some of the highest levels of diabetes, hypertension, and other disabilities. Their health problems limit their ability to continue working. But many Black women have to continue working because of declining income as they age.
“’And so, it’s sort of a Catch-22,’ said Brown. ‘They’re often sort of put in a bind there.’”
Continue reading this article at The Crisis, click here.
“A recently submitted bill in the US Senate seeks to make permanent several emergency telehealth measures enacted during the pandemic.”
by Erik Wicklund
“A group of Senators has submitted yet another bill aimed at permanently extending Medicare coverage for certain telehealth services beyond the pandemic.
“The Protecting Rural Telehealth Access Act (S. 1988), introduced this week by Senators Joe Manchin (D-WV), Joni Ernst (R-IA), Jeanne Shaheen (D-NH) and Terry Moran (R-KS), reportedly aims to improve access to and coverage of connected health services in rural parts of the country. It would continue several emergency measures enacted during the COVID-19 public health emergency.
“In a press release, Manchin and his colleagues said the bill would:
- Allow payment-parity for audio-only telehealth services for clinically appropriate appointments;
- Permanently waive geographic restrictions in Medicare coverage, allowing patients to be treated in their homes;
- Permanently allow Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to serve as distant sites for providing telehealth services;
- Expand coverage for asynchronous (store-and-forward) telehealth services; and
- Allow Critical Access Hospitals (CAHs) to directly bill for telehealth services.”
Continue reading this article at mHealthIntelligence.com, click here.
Harrisburg, PA – The Pennsylvania Department of Aging today encouraged Medicare beneficiaries to make the most of their preventive benefits that could help them save money and live healthier lives through preventive care. The department recently launched a five-week media campaign to promote awareness of these benefits.
Beneficiaries who have Medicare Part A and B and limited income and resources may qualify to have a Medicare Savings Program pay a portion of their premium each month. Those with Medicare Part D and who have limited finances and resources may qualify for Extra Help, which lowers the cost of coverage and prescriptions.
Older adults enrolled in original Medicare or a Medicare Advantage Plan may benefit from preventive services that may be free or at a low cost under certain guidelines. These preventive services are:
“Navigating the Medicare system sometimes can be difficult. Once beneficiaries are aware of how they can make their benefits work for them, they will see greater health outcomes,” said Susan Neff, APPRISE director. “Our trained staff and volunteers look forward to speaking with Medicare beneficiaries who are interested in hearing about these preventive benefits in their plan or discuss ways to save money through Extra Help or a Medicare Savings Program.”
Medicare beneficiaries with questions or wanting to learn more information can call the APPRISE Helpline at 1-800-783-7067.
APPRISE is Pennsylvania’s State Health Insurance Assistance Program with nearly 800 trained counselors available who provide free, confidential, objective, and easy-to-understand information about original Medicare, Medicare Advantage Plans, prescription drug plans, and Medicare Supplement plans, and allows Medicare beneficiaries to compare plans and determine what best meets their needs and save them money.
To learn more about the APPRISE Program or becoming a volunteer, click here.
Credit: Next Avenue | John Gilman
by Jackson Rainer
“’Most people spend more time looking for their next car than they do looking for their doctor” is an old and familiar adage among medical professionals.
“But one of the most important and proactive steps to protecting your future self is building and maintaining a stable care team that nourishes and supports all aspects of your health.
“If you seek out care only in crisis, you’re more likely to receive care that isn’t a good match or aligned with your preferences and health goals.
“This guide explores how to choose a health care provider or replace a retired one, build relationships with physicians and access specialty care.
“To stay grounded in fact, look for physicians who rely on evidence-based practices.”
“The year 2020, the bicentennial of Florence Nightingale’s birth, was designated by the World Health Organization (WHO) as the International Year of the Nurse and the Midwife. According to WHO, ‘Nurses and midwives play a vital role in providing health services. These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs. They are often, the first and only point of care in their communities.’”
“American Jobs Act proposes big dollars for caregiving — here’s the bigger vision it lacks” – The Hill
“It’s about time we as a nation acknowledged the critical importance of caring for adults in their fragile years to both the economy and the fabric of our society.”
by Amy Cameron O’Rourke, opinion contributor
Study | “Medicare Advantage beneficiaries save more money on out-of-pocket costs than Medicare fee-for-service” – Fierce Healthcare
“Medicare Advantage offers care for more low-income individuals compared with traditional Medicare, a new analysis from Better Medicare Alliance said.” (Getty/zimmytws) “Better Medicare Alliance is the nation’s leading research and advocacy organization supporting Medicare Advantage. Together, we are over 150 Ally organizations from across the health care spectrum and more than 500,000 grassroots beneficiary advocates united in our mission to build a healthier future through a strong Medicare Advantage.” – Better Medicare Alliance
by Robert King
“Medicare Advantage plan holders spend $1,640 less a year compared with traditional fee-for-service, a new analysis finds.
“The analysis released Tuesday from the advocacy group Better Medicare Alliance also found that lower-income Medicare beneficiaries are more likely to choose MA over the traditional program.
“Beneficiaries in MA reported out-of-pocket and premium spending of $3,354 a year in 2018, compared with $4,994 in fee-for-service, the analysis added. That was a $42 increase since 2017.
“’This results in a 40% lower cost burden for consumers than traditional Medicare’” said Allyson Schwartz, president and CEO of Better Medicare Alliance, in a statement. ‘The consumer savings in Medicare Advantage translates to meaningful financial security and peace of mind for millions of beneficiaries.’
“The analysis also found that more than 40% of beneficiaries who make under 200% of the federal poverty level were enrolled in MA, compared with 27% of beneficiaries that make more than 400% of the poverty level.”