Part D Fun Facts

Some fun facts from Kaiser Family Foundation about Medicare Part D, which covers prescription drugs. Enrollment has doubled since Part D’s inception in 2019. Enrollment in managed care drug plans (i.e., Medicare Advantage Part D Plans [MA-PD]) has continued to grow, but enrollment in stand alone Part D Plans [PDP] has leveled off or decreased.…

Medicare, adverse selection and cancer

Conventional wisdom holds that Medicare Advantage provides better service and lower cost sharing than traditional Medicare fee-for-service, and thus is attractive for many people.  However, Medicare Advantage may restrict access to providers and may be less attractive to patients with more severe illnesses.  Healthcare economists, however, do not rely on rumors and stories to make…

Is Medicare Advantage risk adjustment fair? And if not, what should we do about it?

While most patients in Medicare use the traditional fee-for-service route, a growing percentage of Medicare beneficiaries are relying on managed care plans through Medicare Advantage.  Medicare Advantage provides beneficiaries with additional choice and also serves as a competitive alternative to traditional Medicare.  In theory, Medicare should just allocate a beneficiary’s funding to a managed care…

Will Medicare Advantage be the future of Alternative Payment Models

CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage).  Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…

Medicare Advantage and Upcoding

Medicare’s cost are growing due to an aging population, technological advances, and other factors.  One of those factors may be upcoding that is occurring among Medicare Advantage plans.  Rick Kronick writes in Health Affairs that: Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service…

VBID comes to Medicare Advantage

CMS announced last week that they are extending their value-based insurance design (VBID) program to more states and more patients.  I describe VBID and the proposed changes below. What is VBID? Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees…