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How Do Medicare Advantage, Medicare Supplemental Insurance Differ?

July 20, 2018 - Medicare Advantage (MA) and Medicare supplemental insurance, or Medigap, are both intended to enhance the value of traditional Medicare coverage for seniors and other eligible beneficiaries. Both offer payers a lucrative opportunity to meet a growing demand for high-quality benefits at a low cost. The US Census Bureau predicts that almost 78 million people will be 65 and older by 2035. B...For example, Medigap policies for Part A can help beneficiaries cover 100 percent of their hospital coinsurance costs. Supplemental insurance plans are divided into categories with an alphabetic label.  Medigap plans in tiers A through K provide the highest cost sharing benefits, while plans K through N plans provide less cost coverage. CMS will no longer provide “Medigap F&rd...


Articles

Pros and Cons of Small Business Health Options Program Health Plans

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Health plans offered through the Small Business Health Options Program (SHOP) exchanges allow payers to provide the nation’s smallest businesses with affordable plan options that offer critical health benefits. SHOP health plans opera...

Emergency Physician Group Sues Anthem for ED Payment Policies

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The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have filed a lawsuit against Anthem BCBS of Georgia contesting an emergency department payment policy that makes patients responsible for cover...

Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

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The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage be...Medicare Advantage has roughly 500,000 more beneficiaries than the Medicare fee-for-service program, but each program has nearly the same prevalence of chronic diseases in their populations. Both MA and Medicare FFS population have a diabet...

Health Plan Cost Sharing, Deductibles Outpace Members’ Wage Growth

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Health plan cost sharing and deductible spending have outpaced employee wage growth in the last ten years, according to data released by the Peterson-Kaiser Health System Tracker. Employees’ total financial responsibility increased by...In 2016, employees spent an average of $417 for deductibles, $249 for coinsurance, and $140 on copays. The team found that even though costs grew, employer-sponsored health plans began to cut back on spending for care costs. “Overall,...

Partners HealthCare to Self-Insure 100K Employees

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Partners HealthCare has announced it will self-insure 100,000 of its employees, transitioning coverage from BlueCross BlueShield of Massachusetts to its own Neighborhood Health Plan, according to The Boston Globe. “Neighborhood Health...

Customer Satisfaction with Medicare Advantage Health Plans Remain Low

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Medicare Advantage (MA) plans are not meeting their customer satisfaction goals, and tend to leave consumers feeling less-than-pleased with the way health plans communicate and the availability of financial information, according to a new J...

Humana, Walgreens Offer Primary Care Clinics for Medicare Members

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Humana and Walgreens have announced the launch of two primary care clinics, designed to meet the needs of Medicare beneficiaries, that will operate within Walgreens locations in the Kansas City area. The collaboration, led by a Humana subsi...

Amazon, Berkshire, JPMorgan Name Atul Gawande Healthcare CEO

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Amazon, Berkshire Hathaway, and JPMorgan Chase have named Atul Gawande, a surgeon at Brigham & Women’s Hospital, as the CEO of their joint healthcare company. The company will be headquartered in Boston, Massachusetts. Gawande wil...

BlueCross BlueShield Nets $2.3B in Savings from 2017 Tax Cuts

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BlueCross BlueShield companies saw  a total tax savings of $2.3 billion after passage of last year’s Tax Cuts and Jobs Act (TCJA), according to a new creditor’s briefing from AM Best. BCBS companies reported a mix of gains ...Horizon Healthcare Services plans to use their tax break to improve behavioral and mental healthcare for their members and return $125 million directly back to their beneficiaries. Other BCBS payers also committed to using the funds to lowe...

Humana, Roche Diagnostics Face $45M Federal Kickback Lawsuit

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Humana and Roche Diagnostics will face a $45 million federal kickback lawsuit after a whistleblower filed a False Claims Act violation, which alleges Roche tried to entice Humana financially to secure access to the payer’s business op...

Private Payers Deny Hepatitis C Drug Coverage to 52% of Members

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Private payers denied Hepatitis C drug coverage to 52.4 percent of commercially insured beneficiaries from 2014 to 2017, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Hepatitis C drug acce...

BCBS of TX Delays Non-Emergency ED Claims Review Policy

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BlueCross BlueShield of Texas has delayed implementation of a claims review policy that would require HMO members to pay the total cost of an emergency department visit if the encounter is later deemed to be a non-emergency, according to a ...

Amazon, Berkshire Hathaway, JP Morgan to Name Healthcare CEO

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The new Amazon, Berkshire Hathaway, and JP Morgan & Chase healthcare company will have its inaugural CEO in the next two weeks, Berkshire Hathaway’s CEO Warren Buffett told CNBC in an interview. Buffett was joined by Jam...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

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Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have al...

WellCare Buys Meridian for $2.5B to Grow Medicaid Footprint

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WellCare has entered into a definitive agreement to purchase Meridian Health Plan of Michigan, Meridian Health Plan of Illinois, and MeridianRx in order to increase revenues and expand its footprint in the Medicaid and Medicare Advantage ma...

Short-Term Wellness Interventions Improve Employee Well-Being

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Short-term wellness interventions can improve employee well-being and may help employers reduce their overall costs while maintaining employee health and productivity, according to a new study published in the American Journal of Health Pro...

Pros and Cons of High Cost Sharing for Employer Health Plans

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Employer-sponsored health plans that include high cost sharing expectations can help control spending for plan sponsors, but could create longer-term health risks for employee beneficiaries.   Striking the right balance between lowerin...

How Payers Identify, Succeed in Health Plan Market Opportunities

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Healthcare payers that wish to be known as innovators need to continually be on the lookout for emerging health plan market opportunities that offer strong profit potential. Payers need to monitor specific market indicators and implement ne...

Assessing Providers for Participation in Value-Based Care Contracts

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Creating strong networks of high-quality healthcare providers can be a major challenge for any payer looking to expand its value-based care contract portfolio. Providers aren’t the only ones accepting risk when entering into pay-for-p...

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