Medicare Advantage and Part D

From Medicare Advantage News - It did not take long in 2015 for the first new Part D battle to erupt between a major insurer and a large trade group for independent retail pharmacies. The 23,000-member National Community Pharmacists Association (NCPA) on Jan. 7 rebuked Aetna Inc. for listing on the company’s websites and the CMS Medicare Plan Finder as in-network for 2015 numerous pharmacies that turned out not to be in most cases. Since Aetna did not admit or fix the problem until after the Annual Election Period (AEP) ended Dec. 7, Part D beneficiaries may have been victims of “bait and switch” tactics,… Read more

From Medicare Advantage News - Providers in Humana Inc.’s Accountable Care Continuum programs in Medicare Advantage got much higher HEDIS scores than did its providers outside of those settings in Medicare, and the scores improved as the degree of provider risk-bearing increased (see chart, this page), the company said this month. The comparisons also showed that Humana’s MA members in accountable care programs had 7% fewer emergency room (ER) visits per 1,000 patients and 4%… Read more

Medicare Advantage & Part D Blog

By James Gutman - March 4, 2015
It has become sort of a game in recent years predicting what adjustments will appear on Medicare Advantage payment rates in the “45-day notice” and final notice in order for CMS to get to where it wants — and the laws require — on the rates for the following year. And while consultants and...
By James Gutman - February 18, 2015
The full picture of how the 2015 Annual Election Period (AEP) was for Medicare Advantage (MA) plans finally emerged Feb. 11 when CMS posted the February enrollment data, and the answers in two words are “good” and “perplexing.” The “good” stems from an approximately 342,000 gain in MA membership...
By James Gutman - February 12, 2015
Remember hearing about the big CMS Medicare Advantage (MA) and Part D final rule that had been at the White House Office of Management and Budget (OMB) for months, stirring up all kind of trepidation about what may be in it now that the elections are over? Well, it came out Feb. 6, and basically...

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