Insurance plan members find themselves involuntarily switched between plans; the Senate investigates patient safety concerns resulting from private equity practices; base payments to Medicare Advantage (MA) plans will decrease in 2025.
ACA Enrollees Encounter Unauthorized Plan Switching
Affordable Care Act (ACA) enrollees are experiencing unauthorized plan-switching disruptions to their coverage, driven by rogue agents exploiting vulnerabilities in federal marketplace security, according to Kaiser Health News. Despite record enrollment, complaints have surged, prompting regulatory actions from CMS, yet the efficacy of these measures remains uncertain. Additionally, brokers have reported ongoing concerns amidst new consent rules, highlighting the urgent need for enhanced safeguards to protect consumers and maintain ACA integrity.
Senate Committee Probes Private-Equity Firms' Impact on ED Care
Senator Gary Peters (D, Michigan) is heading a Senate inquiry into private-equity firms' management of hospital emergency departments, prompted by reports of patient safety and care issues, according to NBC News. Requests for information targeted Apollo Global Management, the Blackstone Group, and KKR, along with affiliated companies, aiming to assess the impact of private-equity practices on health care quality and physician autonomy. As private-equity firms increasingly dominate the health care sector, concerns continue to mount over cost-saving measures that potentially compromise patient safety, which have prompted calls for transparency and accountability from industry stakeholders.
Biden Administration Cuts MA Payments
The Biden administration's decision to reduce base payments to Medicare Advantage (MA) plans by an average of 0.16% has triggered a market downturn for major insurers like UnitedHealth, CVS Health, Humana, and Centene, amidst fears of ongoing financial challenges, according to Axios. While risk-adjusted payments may mitigate the impact, insurers expressed worries over continued pressure on seniors' benefits and potential benefit reductions due to rising costs and policy changes. With MA enrollment surging, concerns persist over overpayment and cost escalation.
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Traditional Medicare Supplemental Insurance and the Rise of Medicare Advantage
May 7th 2024Rising Medicare Advantage enrollment occurred alongside declines in enrollment in traditional Medicare with employer-sponsored supplemental coverage and traditional Medicare without supplemental coverage.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
The Senate Finance Committee has introduced bipartisan legislation that proposes using Medicaid and Medicare programs to help prevent and reduce generic drug shortages; US indicators for COVID-19, flu, and respiratory syncytial virus (RSV) declined further last week; findings from a recent study reveal growing disparities in child death rates across racial and ethnic groups.
Read More
Access Denied: CMS’ Action Hurts Patients With Cancer in Rural America
May 6th 2024CMS rules hindered the access of rural patients with cancer to medically integrated pharmacies in 2023. The authors discuss the impact on equity in health care, emphasizing the need for regulatory change.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Traditional Medicare Supplemental Insurance and the Rise of Medicare Advantage
May 7th 2024Rising Medicare Advantage enrollment occurred alongside declines in enrollment in traditional Medicare with employer-sponsored supplemental coverage and traditional Medicare without supplemental coverage.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
The Senate Finance Committee has introduced bipartisan legislation that proposes using Medicaid and Medicare programs to help prevent and reduce generic drug shortages; US indicators for COVID-19, flu, and respiratory syncytial virus (RSV) declined further last week; findings from a recent study reveal growing disparities in child death rates across racial and ethnic groups.
Read More
Access Denied: CMS’ Action Hurts Patients With Cancer in Rural America
May 6th 2024CMS rules hindered the access of rural patients with cancer to medically integrated pharmacies in 2023. The authors discuss the impact on equity in health care, emphasizing the need for regulatory change.
Read More
2 Commerce Drive
Cranbury, NJ 08512