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Medicare News

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June 10, 2021

Currently, more than 18 million Americans are enrolled in Medicare Advantage plans, with roughly one-third of all Medicare beneficiaries opting for one. Americans are not only enrolling in these affordable Medicare solutions in greater numbers, but they are also satisfied with them.

So, what’s the catch? Medicare Advantage has created a plan that provides subscribers with affordable, high-quality, patient-centered care with a wide range of options while also motivating providers to keep people healthy.

While the affordable Medicare solution is not without flaws, it has proven to be a success that the healthcare profession can learn from. From the pages of Medicare Advantage’s playbook, we can learn a few things.

Keep care affordable with accurate compensation for insurers

For starters, Medicare Advantage has devised an incentive scheme that rewards insurers equitably for providing value-based care. However, this wasn’t always the case. In the beginning, Medicare Advantage insurers were paid the same amount for everyone registered in their health plan, regardless of whether they were affordable or had complicated chronic diseases.

As a result, the government seemed to compensate healthy enrollees while underpaying sicker ones. As a result, insurers were compelled to enroll healthy patients while avoiding sicker ones, creating a barrier to providing high-quality, affordable Medicare solutions to those who needed them.

The Centers for Medicare & Medicaid Services (CMS) adopted risk adjustment for Medicare Advantage plans in 2004 to address this issue. Risk adjustment, in general, describes a single individual’s health and well-being, aggregates the health of all individuals throughout a plan, and then determines how much a single insurance company or healthcare provider will be paid per patient.

These payments are determined by how sick or healthy a member is, ensuring that sick patients receive the affordable Medicare solutions they require and that physicians get compensated for providing that care. Because Medicare Advantage plans are reimbursed for the average cost of caring for an individual, it incentivizes organizations to provide cost-effective care to a population.

With such results, it’s simple to understand why Medicare Advantage’s use of risk adjustment is a valuable lesson for the government as it seeks to bend the expense curve of Medicare and healthcare in general while preserving access and quality.

Incentivize comprehensive care coordination for better care outcomes

An affordable Medicare plan’s success isn’t determined solely by its ability to control costs; it must also produce high-quality outcomes. Chronic disease management and care coordination are directly impacted and improved by Medicare Advantage.

Provider networks operating under Medicare Advantage models, on the other hand, have a global budget related to their capacity to track and report on care coordination, clinical results, and beneficiary satisfaction.

This encourages practitioners to accurately document clinical diagnoses in order to guarantee that beneficiaries receive the care management and related services that are suitable for their condition. Effective recording and diagnosis have been shown to lead to earlier treatment interventions, higher treatment rates, affordable Medicare solutions, and improved health outcomes.

A path forward

Certainly, Medicare Advantage has its share of difficult difficulties. However, it is apparent that it is a successful aspect of the healthcare system that has provided improved value for each healthcare dollar spent for both enrollees and the government.

Take a look at Medicare Advantage and its value-based approach to managing it as government officials and the industry navigate the healthcare changes and learn from what works.

Meanwhile, if you’re looking for affordable Medicare solutions for senior health, choose National Senior Services. We are here to help you locate the correct coverage by guiding you through the process step by step. With so many alternatives and variables to consider, we can assist you to understand which plan or plans will work best for you

chris dsouaz

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February 1, 2017

Although popular love songs might tell you otherwise, a broken heart can’t kill you—but heart disease can. Heart disease is the leading cause of death in the United States for both men and women, taking about 610,000 lives each year—that’s 1 in every 4 deaths.

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and help prevent heart disease. Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease.

Medicare covers a cardiovascular disease screening at no cost to you every 5 years. The screening includes tests to help detect heart disease early and measures cholesterol, blood fat (lipids), and triglyceride levels.

If you and your doctor discover that you’re at risk for a heart attack or stroke, there are steps you can take to help prevent these conditions. You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.

February is American Heart month, so start showing your heart love by visiting the Million Hearts® Healthy Eating & Lifestyle Resource Center. Million Hearts is a national initiative to prevent 1 million heart attacks and strokes by the end of this year. The resource center was developed in partnership with EatingWell magazine, and features lower sodium, heart-healthy recipes and family-friendly meal plans to help manage sodium intake, a major contributor to high blood pressure and heart disease. All the recipes include nutritional facts and average cost per serving information. Use the search and filter options to quickly find the right meal for yourself and your family.

While you’re celebrating family and friends this Valentine’s Day, don’t forget to show your heart some love, too.

Filed under: Medicare coverage, Uncategorized

R Fisher

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January 18, 2017

If you’re among the 7 million Americans enrolled in the Qualified Medicare Beneficiary (QMB) Program, providers aren’t allowed to bill you for medical services and items that Medicare covers. This means you can’t be billed for Medicare deductibles, coinsurance, and copayments.

Here are 3 tips if you get a bill for these charges:

  1. Tell the provider or debt collector that you have QMB and can’t be charged for Medicare deductibles, coinsurance, and copayments. Show your provider your Medicaid or QMB card every time you get medical services or items. If you already made payments on a bill for services and items Medicare covers, you have the right to a refund.
  2. If the medical provider won’t stop billing you, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. The agent can confirm that you have QMB. Medicare can also ask the provider to stop improper billing, and refund any incorrect payments you made.
  3. If you have a problem with debt collection, you can send a complaint to the Consumer Financial Protection Bureau (CFPB) online or call the CFPB toll-free at (855) 411-2372. TTY users can call (855) 729-2372. CFPB will forward your complaint to the company and work to get you a response from them. Find out about your rights when responding to a debt collector or learn how to dispute an error on your credit report.

Remember, being in QMB means that you don’t pay Medicare deductibles, coinsurance, and copayments. If a provider asks you to pay, that’s illegal. We’re here to help.

Filed under: Uncategorized

R Fisher

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January 15, 2017

Are you at a high risk of getting glaucoma? Glaucoma is an eye disease that causes loss of vision—usually side vision—by damaging the optic nerve, which sends information from your eyes to your brain.

Fortunately, you can help prevent vision loss by finding and treating problems early—and Medicare can help. We cover a glaucoma screening once every 12 months for people at high risk for glaucoma. You’re considered at high risk if you answer “yes” to one or more of these questions:

  • Do you have diabetes or a family history of glaucoma?
  • Are you African American and 50 or older?
  • Are you Hispanic American and 65 or older?

January is National Glaucoma Awareness Month—the perfect time to check on your eye health.

Watch our glaucoma awareness video to learn more.

Filed under: Medicare coverage, Uncategorized

R Fisher

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January 1, 2017

About 12,000 women in the United States are diagnosed with cervical cancer every year. All women are at risk, but it occurs most often in women over 30. Fortunately, it’s one of the easiest female cancers to prevent. There are 2 screening tests to find cervical cancer early.

Medicare covers the HPV test and Pap tests every 24 months for all women and every 12 months if you’re at high risk. The CDC recommends getting regular pap tests starting at 21.

January is Cervical Health Awareness Month. Watch our Cervical Health Awareness Month video and visit our cervical & vaginal cancer screenings page to learn more about these tests.

 

Filed under: Medicare coverage, Uncategorized

R Fisher

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National Senior Services is not connected with or endorsed by the US government or the federal Medicare program; Medicare has neither reviewed nor endorsed this information. We are a licensed and approved Medicare Service Provider.

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RT : The links between heart disease and stress are clear so have a good laugh today.

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