CMS Holds the Line Against Insurance Industry Pressure, but Plans Remain Significantly Overpaid. As discussed in recent CMA Alerts (see, e.g., here and here), in late January this year the Centers for Medicare & Medicaid Services (CMS) issued … [Read more...] about Medicare Advantage Payment Rates for 2025 Released
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Medicare Program Cannot Afford Medicare Advantage “Stability” – Especially as New Study Shows Inferior Home Health Care Provided by MA Plans
MA Overpayment As discussed in a recent CMA Alert (Feb. 22, 2024), the Centers for Medicare & Medicaid Services (CMS) has issued proposed MA payment rates for 2025 (“Rate Notice”), which will be finalized by April 1, 2024. As described … [Read more...] about Medicare Program Cannot Afford Medicare Advantage “Stability” – Especially as New Study Shows Inferior Home Health Care Provided by MA Plans
Medicare Advantage Proposed Payment for 2025 and Other Updates
The Centers for Medicare & Medicaid Services (CMS) has issued proposed Medicare Advantage (MA) and Part D payment rates for 2025. As discussed below, the insurance industry is already trying to pressure the agency to increase their payment in … [Read more...] about Medicare Advantage Proposed Payment for 2025 and Other Updates
When Should Medicare Coverage Be Available For Skilled Nursing Facility (SNF) Care?
Skilled Nursing Facility (SNF) care can be covered by Medicare if it meets the following criteria: Note: Medicare Advantage plans often do not require a prior hospital stay to qualify for SNF coverage. Note: “Daily” is defined as seven … [Read more...] about When Should Medicare Coverage Be Available For Skilled Nursing Facility (SNF) Care?
When Should Medicare Coverage be Available for Home Health Care?
Home health care can be covered by Medicare if it meets the following criteria: Medicare Coverable Home Health Services If the triggering conditions described above are met, the beneficiary is eligible for Medicare coverage of home health … [Read more...] about When Should Medicare Coverage be Available for Home Health Care?
Medicare Program Proposes to Increase Medicare Advantage Payment for 2025
On January 31, the Centers for Medicare & Medicaid Services (CMS) released an Advance Rate Notice proposing an overall pay increase to MA plans of 3.7% in 2025 (see CMS fact sheet here). According to CMS, “This is over a $16 billion increase in … [Read more...] about Medicare Program Proposes to Increase Medicare Advantage Payment for 2025
When Should Medicare Coverage be Available for Outpatient Therapy?
Physical, speech-language pathology, and occupational therapies can be covered by Medicare Part B if they meet the following criteria: Other Important Points: … [Read more...] about When Should Medicare Coverage be Available for Outpatient Therapy?
Proposal Could Expand Adult Dental Benefits in ACA plans
The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule regarding the Notice of Benefit and Payment Parameters (NBPP) for 2025, which outlines new parameters and regulations for insurance sold on the Affordable Care … [Read more...] about Proposal Could Expand Adult Dental Benefits in ACA plans
Issue Brief 82 | November 2023 – New report on Medicare Advantage Overpayments & Other Issues
I. NEW REPORT ON MEDICARE ADVANTAGE OVERPAYMENTS On October 4, 2023, Physicians for a National Health Program (PNHP) released a report titled “Our Payments Their Profits”, showing that insurance companies offering Medicare Advantage (MA) plans … [Read more...] about Issue Brief 82 | November 2023 – New report on Medicare Advantage Overpayments & Other Issues
Medicare Advantage Focus: Drawbacks During Annual Enrollment Period
As Medicare’s annual enrollment period proceeds through December 7th, during which beneficiaries can make changes to their Medicare Advantage (MA) and/or Part D coverage, Medicare beneficiaries continue to be bombarded with advertisements and sales … [Read more...] about Medicare Advantage Focus: Drawbacks During Annual Enrollment Period