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Monthly Archives: December 2012

Medicare Premiums, Co-Payments, and Deductibles for 2013

Medicare premiums, deductibles, and co-payments are updated each calendar year based on formulas set by Congress in statute. For 2013, the new Medicare deductible, coinsurance, and monthly premium rates for Part A and Part B are described below. These apply to most but not all Medicare beneficiaries.  Full-benefit dual eligibles - folks who are enrolled in both Medicare Part A and...

Integrated Care for Medicare-Medicaid Dual Eligibles: CMS Grants for Implementation of State Demonstrations

To support demonstrations to integrate Medicare and Medicaid for dual eligibles, the Centers for Medicare and Medicaid Services (CMS) offering state Medicaid agencies grants of up to $15 million each.  The funds are for implementation of CMS approved designs to integrate care for Medicare-Medicaid enrollees.  Most of the state demonstrations involve the use of integrated health plans that will...

Medicaid Primary Care Payment Increase: CMS Answers State Questions on 73 Percent Rate Increase

State Medicaid programs must increase primary care physician payment rates in 2013 and 2014 to at least 100 percent of Medicare rates.  The Medicaid-Medicare payment parity mandate is part of the Affordable Care Act (ACA). For the difference between prior rates and the necessary rate increase, states will receive a 100 percent federal match (rather than the standard 50-77 percent federal...

Seven Ideas to Reduce Costs and Improve Outcomes in Medicare and Medicaid

Medicare and Medicaid spending will exceed $1 trillion in FY 2013.  Together, the two programs now serve about 113 million Americans - over a third of the population.  Policymakers in Washington and the states face a daunting challenge to containing costs in Medicare and Medicaid – both health programs are fiscally unsustainable and must be reformed.  However, it’s important that...

Hospitalization of Seniors from Nursing Homes: High Cost of Avoidable Hospital Admissions of Elderly

The cost of hospitalizations, particularly hospital readmissions, is increasingly a concern for Medicare, Medicaid, and private health plans. The Centers for Medicare and Medicaid Services (CMS) in particular has emphasized reducing hospitalizations and readmissions. Results from the CMS Medicare Coordinated Care Demonstration pilot project show coordinated care for Medicare patients reduces hospitalizations and is cost-neutral, according to two recent...

Health Insurance Exchanges, Market Reforms, and Medicaid Expansion: CMS Answers 39 State Questions on ACA Implementation

Health Insurance Exchanges, new health insurance market rules, and Medicaid expansion under the Affordable Care Act (ACA) presents states with a massive array of policy, fiscal, and technical challenges.  In sheer complexity, magnitude of change, and impact on consumers, employers, health care providers, government programs, and taxpayers, ACA is unprecedented. States raised a series of policy and technical questions to...

Medicare-Medicaid Dual Eligibles: Consumer Protection Requirements Vary by Program and State

Enrollees in both Medicare and Medicaid, called dual eligibles, are the most expensive and vulnerable group of beneficiaries. More than 40 percent of dual eligibles have severe cognitive disabilities, are likely to have severe physical disabilities, and have higher rates of chronic disease, such as diabetes and Alzheimer’s. All dual eligibles have low incomes, and most are more than...

Medical Cost of Injuries: Trauma Related Disorders Among the Top 5 for Health Costs

Cost containment efforts often focus on types of patients or conditions that are most expensive, not surprisingly. For example, integrated Medicare-Medicaid health plan demonstrations are one potential solution to control costs for dual eligibles, who are expected to account for 39 percent of Medicaid spending and 31 percent of Medicare spending - about $350 billion in total - in...

Medicaid Long-Term Services and Supports: ACA Policies Promote Home and Community-Based Care

Much of the nation's long-term care is paid for with Medicaid funding. Medicaid pays 43 percent of all long-term care, while Medicare pays 24 percent and a mix of private health plans and consumers funds the rest, according to the Kaiser Family Foundation. Only half of people who need long-term care are elderly. The other half are younger than...

Healthcare-Associated Infections: Strategies to Reduce HAIs in Hospitals and Other Facilities

Healthcare-associated infections (HAI) contribute significantly to U.S. health costs and spending. They can be a major problem in hospitals, with one in every 20 hospitalized patients contracting a healthcare-associated infection, according to the Centers for Disease Control and Prevention (CDC). Each year, HAIs kill more than 1.7 million people and cost hospitals between $28 billion and $45 billion. Eighty percent...

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