![]() 4 Lastly, long stays in nursing homes have decreased. 5 In California, enrollees reported a 20% decrease in hospitalizations. Data from an independent federal evaluation show decreased hospitalizations in Ohio (20%) and Washington (5%). 4 Second, hospitalizations have decreased. In an independent evaluation in California, enrollees reported a higher level of satisfaction than those remaining in their original Medicare. While transitions from fee‐for‐service to managed care can be challenging, enrollees in many demonstration states report high levels of satisfaction. Given the complexity of implementing these pilots, findings are preliminary and lack significant cost and quality data, yet early federal and state evaluations show clear patterns of improvement in care delivery and beneficiary experience for those enrolled in specific Medicare‐Medicaid Plans (MMPs). We are now six years into this audacious set of pilots, which involve 12 states and nearly 440,000 people. The Medicare‐Medicaid Coordination Office with its Financial Alignment Demonstration was specifically created to allow states to step forward and develop models that could substantially improve care for beneficiaries while delivering savings to states and the federal programs. While there are many examples of small‐scale programs that have integrated care and financing for Medicare‐Medicaid eligible individuals, implementation at large scale has been elusive, often limited by concerns that savings will not materialize. Generally speaking, better models of care that deliver savings in one program often result in increased utilization and, hence, greater spending in the other. 2 The challenge is that these two programs have a long history of operating in their own silos and not coordinating their financing or benefits. 1 However, the top 5% of Medicare utilizers represent 40% of Medicare spending-and roughly half of these individuals are also eligible for Medicaid. Private long‐term care insurance has never held more than 8% of the market, and Medicare pays only for short‐term, post‐acute care. Today Medicaid and personal out‐of‐pocket spending are the top payers for long‐term services and supports in the United States. ![]() ![]() Adults are living longer, causes of death are more likely associated with chronic health conditions (eg, diabetes), and the need for functional and community‐based supports is vastly greater than was originally envisioned by Medicare's and Medicaid's framers. The inclusion of nursing home care in Medicaid was basically an afterthought. Medicare was intended to pay for hospital and doctors’ costs while Medicaid served as a safety net for low‐income women of childbearing age and their children. The average life expectancy was 69, most of the top 10 causes of death were due to acute health events (eg, heart attack), and most people living with substantial functional impairment did so for only short periods of time before they died. You will also use this card at the pharmacy if your health plan has Medicare prescription drug coverage (Part D).W hen medicare and medicaid were signed into law in the summer of 1965, the American health care landscape looked very different than today. Instead, you will use the membership card your private plan sends you to get health services covered. If you join a Medicare Advantage Plan (like an HMO, PPO, or PFFS), you will not use the red, white, and blue card when you go to the doctor or hospital. You may pay a monthly premium for this coverage, in addition to your Part B premium. Many different kinds of Medicare Advantage Plans are available. You also typically get Part D as part of your Medicare Advantage benefits package (MAPD). Medicare Advantage Plans must offer, at minimum, the same benefits as Original Medicare (those covered under Parts A and B) but can do so with different rules, costs, and coverage restrictions. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare. These Medicare private health plans, such as HMOs and PPOs, contract with the federal government and are known as Medicare Advantage Plans. Part C is the part of Medicare law that allows private health insurance companies to provide Medicare benefits. Medicare Part C is not a separate benefit.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |