Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

New Medicare Advantage Model Aims for Higher-Quality Care at a Lower Cost

September 3, 2015

CMS Announces Value-Based Insurance Design Medicare Advantage Model

This week, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage Value-Based Insurance Design Model (MA-VBID), which will test whether giving Medicare Advantage plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing can lead to higher-quality, lower-cost care.

According to CMS, the goals of the model are to improve health, reduce avoidable high-cost care, and reduce costs. The model focuses on beneficiaries with diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders, and combinations of these categories. It will begin January 1, 2017 and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.

Value-Based Insurance Design (VBID) generally refers to efforts to structure cost-sharing and plan design elements to encourage enrollees to use high-value services—those services that have the greatest potential to positively impact enrollee health at a lower cost than alternatives. “The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” said Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical officer.

Medicare Rights actively weighed in on the development of this model and will submit formal comments on the proposed concept, primarily offering feedback on the proposed beneficiary education scheme and important beneficiary protections.

Click here for more information about the MA-VBID model test.

Commonwealth Fund Brief Analyzes Competition in Medicare Advantage Plan Market

Many see competition in Medicare Advantage (MA) plan markets as necessary to keep premiums low, control spending, and expand benefits. With many health plans planning to consolidate, the Commonwealth Fund recently released a new brief examining how much competition exists in the MA plan market across the country.

According to the brief, 97 percent of MA plan markets in counties across the US “are highly concentrated and therefore lacking significant competition.” While rural areas have less competition than urban areas, in the 100 counties with the highest number of Medicare beneficiaries, 81 percent lack a competitive MA market. Nationwide, the plan market is centered on only three insurance companies in these 100 counties.

The Commonwealth Fund relied on the Herfindahl-Hirschman Index (HHI) to determine the level of concentration in individual markets by analyzing the number of MA insurance companies in a particular market and comparing that with the number of people enrolled. Markets with an HHI below 1,500 are considered nonconcentrated, those with an HHI between 1,500 and 2,500 are moderately concentrated, and markets above 2,500 are highly concentrated.

According to the findings, urban counties make up 95 percent of all MA enrollees and have an average HHI of 3,712 (highly concentrated) while rural counties have an average HHI of 5,245 (also highly concentrated). The national MA market has an average HHI of 3,783. While these results suggest that the MA market is not that competitive, it remains unclear what effect this has on Medicare costs and the quality of services offered.

Click here to read the Commonwealth Fund brief.

Volume 6, Issue 34

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Medicare Reminder

How Medicare covers vaccines depends on the type of vaccine and the reason it is prescribed. Medicare Part B (either through Original Medicare or a Medicare Advantage plan) covers vaccines after you are exposed to a dangerous virus or disease. For example, it will cover tetanus shots after you step on a rusty nail.  It also covers three vaccines under the preventive care benefit – flu, pneumonia, and hepatitis B. All other vaccines should be covered by your Part D prescription drug plan. Every Part D plan must have all commercially available vaccines on its list of covered drugs (formulary), but costs may differ.


Click here to learn more about Part D vaccine coverage on Medicare Interactive.



In a recent article from Kiplinger’s Retirement Report called What You Need to Know About Enrolling in Medicare, the Medicare Rights team, including Joe Baker and Casey Schwarz, offer key advice for those nearing Medicare eligibility who are about to navigate the Medicare enrollment process.

According to Baker, “[Medicare Rights] sees the problem [with understanding the Medicare enrollment process] growing. People’s life situations are more complex.” For example, he says, “…more people are working longer, and many mistakenly think they don’t need to enroll in Medicare at age 65 if they have workplace coverage.”

The article provides useful information about when and how to enroll in Medicare if you are retiring, have insurance through a current employer, are enrolled in a plan in the Marketplace, as well as other common scenarios.

Click here to read more from Kiplinger’s.


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