Closing the ‘Doughnut Hole’ Has Protected Millions of Medicare Beneficiaries From High Drug Costs

Since 2006, Medicare beneficiaries have had access to outpatient prescription drug coverage through Medicare Part D. The standard benefit under Part D includes an annual deductible, an initial coverage period when enrollees pay 25 percent of their drug costs, and catastrophic coverage that limits enrollees’ spending to roughly 5 percent of their drug costs. One of the more striking characteristics of the Medicare Part D benefit is its “doughnut hole,” or coverage gap, where enrollees are required to pay the full …

The Ban on Preexisting Condition Exclusions Helps Older Adults

Most Americans get their health insurance through their employer or through government-sponsored programs like Medicare or Medicaid. People who do not have access to those forms of coverage — for instance, because they are between jobs or are self-employed — typically buy health insurance directly from private insurers on the individual market. Since 2014, the Affordable Care Act (ACA) has provided a critical protection for individuals who seek insurance in this market: It bans insurance companies from considering people’s health …

Stars for Hospital Quality, Help for Consumers

  There’s good news for consumers interested in taking more control of their health care. On Wednesday, the Centers for Medicare and Medicaid Services (CMS) released quality star ratings for U.S. hospitals, an online resource for consumers. With this release, consumers and family caregivers will have an easy-to-use, easy-to-understand tool to help them evaluate the quality of hospitals. The star rating provides a summary of a hospital’s performance on over 60 quality measures reported on CMS’ Hospital Compare website, in …

Notice to Medicare observation patients misses the mark

If you’re one of the roughly 2 million Medicare beneficiaries placed under observation each year, there’s (potentially) good news for you: You may be less vulnerable to sticker shock when you get your medical bill. But Medicare hasn’t gotten the details right just yet. In less than two months, the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act will require hospitals nationwide to notify Medicare observation patients that they are not formally admitted as inpatients and why. …

Diabetes Prevention Program Shows Investing in Prevention Pays

Diabetes among older adults is associated with significant health and cost burdens. Nearly a quarter of individuals age 65 and older have been diagnosed with diabetes, and one of every three Medicare dollars is spent on beneficiaries living with the condition. An estimated one-half of the Medicare population is prediabetic, meaning their blood sugar levels are high but not high enough to warrant a diabetes diagnosis. To address this growing public health concern, in 2011 the Centers for Medicare & …

Building Capacity to Provide Behavioral Health Services to Dual Eligibles

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative (the Initiative) to improve the quality of care received by low-income adults who are eligible for Medicare and Medicaid — known as dual eligibles. Many of these individuals have unmet behavioral health needs, ranging from mild depression to serious mental illness, like schizophrenia and bipolar disorder. A recent update on the Initiative presented to the Medicare Payment Advisory Commission highlighted four challenges to providing behavioral health services …