Washington, D.C.—Sierra Health Services recently disclosed a $2 million monthly loss from its Medicare full donut-hole-coverage prescription drug plan (PDP), blamed the financial problem on a competitor, and decided to sell out to the leader in the field. Sierra executives say they will drop the Sierra Rx Plus plan, which pays for brand-name drugs through the Medicare coverage gap for its 42,000 members, and the new owner, UnitedHealth Group is unlikely to question that decision.
Washington, D.C.—While members of the Medicare Payment Advisory Commission (MedPAC) may be willing to go slow on proposals to reduce rates for Medicare Advantage (MA) plans overall, they are leery about the fast growth and high cost of private fee-for-service plans. MedPAC members generally believe that payments to MA plans should be comparable with the cost of the traditional Medicare FFS program and that it is inequitable for seniors to receive better benefits from MA plans. They are unhappy over analysis that shows that Medicare pays MA plans 16% on average more than the cost of care under FFS. This breaks out to 15% excess payment to local HMOs, but 22% higher rates for private FFS plans, a newer type of private plan that is growing fast: PFFS plans have attracted 66% more seniors since last August to serve more than 1.3 million Medicare beneficiaries as of February.
Washington, D.C.—The need to reauthorize the Prescription Drug User Fee Act (PDUFA) before it expires Sept. 30, 2007, has set the stage for Congressional action on broader legislation to enhance government regulation of drug safety. Bills under consideration aim to expand Food and Drug Administration (FDA) oversight by establishing new requirements for postmarket risk assessment, for posting information on active clinical trials and the resulting study data, and for completing agreed-upon postmarketing studies.
Most Medicare Advantage and Part D sponsors share a common goal: make Medicare a more profitable line of business. To help alleviate some of the challenges associated with enrollment practices, consider the following tips:
The Bush administration spending plan for 2008 proposes major funding curbs for Medicare, Medicaid, children's health and other government health programs.
Millions of people's lives have been influenced by the work of Mollie Orshansky, even though very few people know who she is. Dozens of health-related programs throughout history have benefitted from Mollie's contributions, including programs through HHS, charitable agencies, private companies and managed care. In 1963, it was Mollie—an accomplished mathematical genius and daughter of a poor immigrant family—who developed the U.S. government's official measure of poverty and the guidelines for what we call the Federal Poverty Level (FPL) today.
Some health insurers are hoping that new benefit designs targeting individuals will attract some of the uninsured and the self-employed, who either don't realize that they can get insurance or don't know how much they can afford.
Detroit's Big Three automakers are considering shifting future retiree healthcare costs to union-controlled trust funds and are eyeing a new contract between Goodyear Tire & Rubber Co. and the United Steelworkers (USW) union.
Rising pressure to reduce federal spending for Medicare has put the spotlight on payments and policies governing the Medicare Advantage program. MA plans are "vastly overpaid," according to Rep. Pete Stark (D-Calif.), chairman of the House Ways & Means Health subcommittee, largely because they sign up more healthy beneficiaries. Senate Finance Committee chairman Max Baucus (D-Mont.) is looking closely at whether "funneling dollars into private plans gets us the most bang for our healthcare buck."
Wal-Mart and the Service Employees International Union (SEIU) have formed what industry watchers have called an "unusual" partnership to push for quality, affordable healthcare.