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How Medicare Advantage Plans Factor Into Aetna-Humana Proposed Mega-Merger

July 19, 2016 Morning Briefing

CNBC reports that if the acquisition gets a regulatory green light, the combined company’s Medicare Advantage enrollment would be nearly 4.5 million members, which is about 25 percent of this year’s national enrollment. Also in the news, compounding pharmacies are increasingly under scrutiny as a new frontier for Medicare fraudsters.

Aetna’s Second Thoughts On Exchange Expansion Latest Blow To Health Law

August 3, 2016 Morning Briefing

The insurer’s decision to reverse course and not expand its Obamacare exchange plans casts doubts on the marketplace’s sustainability. The company also announced it would sell some of its Medicare Advantage plans to help avoid concerns about its proposed merger with Humana.

Urban Medicare Beneficiaries May See More Drug Savings This Year

By Michelle Andrews February 19, 2016 KFF Health News Original

The Centers for Medicare & Medicaid Services says access to special, lower-cost pharmacies has improved for Medicare beneficiaries in urban areas.

Doctors Face Tough Choice With New Options For Reimbursement

August 15, 2016 Morning Briefing

The new doctor payment system established by the Medicare Access and CHIP Reauthorization Act will force providers to opt into one of two reimbursement models that have different risks. Also, Medicare’s efforts to change how the system pays for a variety of different services is hitting opposition in the health care industry, and federal officials have announced changes for some Medicare Advantage plans.

How To Spend Your Final Months At Home, Sweet Home

By Judith Graham November 10, 2016 KFF Health News Original

Older adults who hope to spend the end of their lives at home need to take key steps to make that possible.

Research Roundup: Local Health Resources; Plan Losses; Medicare Advantage Networks

July 1, 2016 Morning Briefing

Each week, KHN compiles a selection of recently released health policy studies and briefs.

New Medicare Payment Plan For Heart Attacks Will Press Hospitals To Monitor Post-Acute Care

July 27, 2016 Morning Briefing

The plan, which will be implemented in nearly 100 communities, will bundle Medicare reimbursements for coronary bypass surgery and heart attack treatments to include care delivered by skilled nursing and rehab facilities. Also in the news, some Medicare beneficiaries are surprised to find out that they have been automatically enrolled in a Medicare Advantage plan.

In Remote Idaho, A Tiny Facility Lights The Way For Stressed Rural Hospitals

By Anna Gorman April 13, 2017 KFF Health News Original

In a region where bears outnumber people, a small medical facility sets a modern example for rural hospitals on life support.

Aetna Seeks To Assuage DOJ’s Anti-Competition Concerns Over Humana Merger

July 11, 2016 Morning Briefing

Company executives met with Justice Department officials on Friday to deliver assurances that they will address competitive concerns through asset sales. WellCare and Centene are among the insurers who have offered to buy its Medicare Advantage plans.

Aetna Reportedly May Sell Medicare Advantage Assets To Ease Concerns About Humana Merger

July 5, 2016 Morning Briefing

The insurance company reportedly hopes the move will help ease antitrust concerns as it seeks an acquisition of another insurer, Humana. Also, federal Medicare officials announce a new rule that will allow some companies access to claims data.

Don’t Just Renew Your Medicare Plan. Shopping Around Can Save Money.

By Susan Jaffe October 15, 2015 KFF Health News Original

Enrollment for private Medicare Advantage and Part D drug plans begins Oct. 15 and consumer advocates urge seniors to check out prices to find the best deals.

GAO: More Oversight Needed Over Medicare Advantage Provider Networks

By Phil Galewitz September 30, 2015 KFF Health News Original

Congressional watchdog says the government checks few health plans to ensure accurate provider listings and adequate access for seniors on Medicare Advantage.

Fueled By Health Law, ‘Concierge Medicine’ Reaches New Markets

By Shefali Luthra January 14, 2016 KFF Health News Original

Doctors, insurers and others are kick-starting experiments to broaden access to direct primary care, a service long associated with only wealthy Americans.

Lawsuit Alleges United Healthcare Overcharged Medicare For Advantage Plan Customers

February 17, 2017 Morning Briefing

The lawsuit, which was unsealed Thursday after a five-year investigation by the Department of Justice, suggests the company may have improperly collected “hundreds of millions” of dollars by claiming patients were sicker than they actually were.

Democratic Candidates Debate ‘Single-Payer,’ But What Does That Mean?

By Julie Rovner January 22, 2016 KFF Health News Original

The phrase often used for government-run health care means different things to different people. Here are five points to help explain the Democrats’ policy clash.

Cigna CEO David Cordani: ACA Marketplace Is Still In ‘Version 1.0’

By Julie Appleby December 7, 2015 KFF Health News Original

In a recent interview, Cordani discussed the evolution of exchange health plans as well the proposed merger between Cigna and Anthem.

Medicare Releases Details From Review Of Advantage Plan Directories’ Accuracy

January 19, 2017 Morning Briefing

The Centers for Medicare & Medicaid Services, which earlier had given a summary that showed overall problems, provides names of companies that fared badly in the survey and other details.

Seniors Who Don’t Consider Switching Drug Plans May Face Steep Price Rise

By Michelle Andrews October 20, 2015 KFF Health News Original

For beneficiaries, staying in their current plans could prove costly so advocates urge them to check out the alternatives.

Watchdog Report Sharply Criticizes Fed’s Efforts To Recoup Medicare Advantage Overcharges

May 10, 2016 Morning Briefing

The Government Accountability Office said that the Centers for Medicare & Medicaid Services has spent about $117 million on Medicare Advantage overbilling audits, but so far has recouped just $14 million. Meanwhile, some Democrats are speaking up for the Medicare Part B change in the face of intense criticism. Also, fee-for-service payments are published and health systems offset Medicare losses.

When Drug Reviewers Leave The FDA, They Often Work For Pharma

By Sydney Lupkin September 27, 2016 KFF Health News Original

Researchers examine the Food and Drug Administration’s “revolving door” regarding employees who worked on cancer and hematology drugs.

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