On August 1, 2022, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) that “seeks input from the public regarding various aspects of the Medicare Advantage program. Responses to this request for … [Read more...] about Medicare Agency is Seeking Comments on Medicare Advantage
Medicare Advantage
Report: Nursing Home MA Issues Survey
The Center for Medicare Advocacy conducted a short survey of skilled nursing facilities (SNFs) in April 2022 after hearing an increasing number of alarming experiences with Medicare Advantage (MA) from CT beneficiaries and SNFs. The goal of the … [Read more...] about Report: Nursing Home MA Issues Survey
NEJM Perspective: ACO REACH – A Progressive Value-Based Payment Model, Promoting Equity
In its “A Year in Review June 2021-May 2022,” CMS cites the introduction of the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) model as a key accomplishment in achieving its strategic initiatives. In … [Read more...] about NEJM Perspective: ACO REACH – A Progressive Value-Based Payment Model, Promoting Equity
Voices of Medicare | Medicare Advantage Network Inadequacy
We recently heard from a Medicare Advantage (MA) enrollee from the Dallas-Forth Worth metropolitan area who went several months without seeing a gastroenterologist due to Cigna’s failure to contract with such specialists. She received no prior notice … [Read more...] about Voices of Medicare | Medicare Advantage Network Inadequacy
Call to Action – Policy Makers Must Increase Medicare Advantage Oversight and Rein in Overpayments
For many years, the Center for Medicare Advocacy has advocated for legislative and administrative efforts to address the growing inequities between Medicare Advantage (MA) and traditional Medicare, that favor MA, and encourage the growing … [Read more...] about Call to Action – Policy Makers Must Increase Medicare Advantage Oversight and Rein in Overpayments
Medicare Advantage is Not the Solution to Medicare Equity or Solvency Problems
By Marilyn Moon, Ph.D. - Center for Medicare Advocacy Visiting Scholar, Medicare Analyst, Former Public Trustee of Medicare and Social SecuritySadly, one of the myths about Medicare Advantage (MA) is that it is better for minorities and persons … [Read more...] about Medicare Advantage is Not the Solution to Medicare Equity or Solvency Problems
Office of Inspector General (OIG) Issues Another Report Highlighting Inappropriate Medicare Advantage Denials
Prior Authorization as a Barrier to CarePrior authorization and other utilization management tools can serve as significant barriers to care that both current and prospective Medicare Advantage enrollees are often unaware of until they need to … [Read more...] about Office of Inspector General (OIG) Issues Another Report Highlighting Inappropriate Medicare Advantage Denials
Insurance Industry v. Provider Response to OIG Report re: MA Denials
The recently issued HHS Office of Inspector General report focusing on Medicare Advantage plan denials titled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary … [Read more...] about Insurance Industry v. Provider Response to OIG Report re: MA Denials
OIG Report Estimates of Inappropriate MA Plan Denials May be Understated
The recently issued HHS Office of Inspector General (OIG) report focusing on Medicare Advantage plan denials titled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically … [Read more...] about OIG Report Estimates of Inappropriate MA Plan Denials May be Understated
(Most) Policymakers Fail to Act on Medicare Advantage Oversight and Overpayment
For many years, the Center for Medicare Advocacy has advocated for legislative and administrative efforts to address the growing inequities between Medicare Advantage (MA) and traditional Medicare that favor MA, and thus encourage the growing … [Read more...] about (Most) Policymakers Fail to Act on Medicare Advantage Oversight and Overpayment