Blog

MACRA Medicare

What is value-based care and how is it different?

What is “Value-Based Care?” Historically, Medicare has been a fee-for-service reimbursement model that promoted the quantity of service, and healthcare providers are reimbursed for services performed. More services and billing codes, plus more reimbursements or payments. This environment created incentives for providers to order more tests and procedures, and of course manage more patients. This hasn’t resulted in better outcomes for patients and has been driving up the cots of healthcare.  

Value-based care, or also known as pay for performance (P4P) healthcare, MACRA, Is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Some examples of performance measures are the reduction of patient hospitalizations, increased preventive services, and management of certain patients’ chronic medical conditions.

In a nutshell, value-based care focuses on patient outcomes and the quality of care being delivered; not quantity. This means that if a physician is effective in treating their patients’ medical conditions, performing preventive screenings, managing chronic conditions, and reducing hospital admissions, they’ll be compensated more for that quality of care. 

When did Medicare begin paying doctors and medical groups for quality rather than quantity?

While limited groups and circumstances have existed for some time, this payment model widely began implementation in 2019. This is a result of the bipartisan legislation MACRA, which passed in 2015.

Here’s what the Centers for Medicare and Medicaid Services (CMS) has to say about the new payment model-

Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. Value-based programs also support our three-part aim:

  • Better care for individuals
  • Better health for populations
  • Lower cost

At Medicare Advocates, we want to ensure that you have a health plan that promotes you and your healthcare outcomes. Talk to us today and we’ll make sure you are getting the most out of Medicare. Click here, to schedule time with an Advocate.

To learn more, please read this article.

Medicare Advantage

Have you heard of Medicare Advantage? If you’re senior aging into Medicare, odds are that you haven’t. However, Medicare Advantage, aka Medicare Part C, is nothing new, seniors have been able to get private healthcare Medicare benefits since the 1970s. Since then, Enrollments have skyrocketed. According to KFF.org, of the 64 million people on Medicare, one third are enrolled in Part C plans.

Medicare Advantage plans are private health insurers that have contracts with Medicare to provide coverage. With a Medicare Advantage plan, you get all the same things that are covered through part A and B, as well as additional benefits that Original Medicare does not cover. Such as eye exams, dental, and hearing. For this reason, Medicare Advantage is also known as part C.

Medicare Part C can also cover prescription drugs. However, if prescription drugs are covered through your Advantage plan, you cannot buy a separate Medicare prescription drug plan. Medicare Prescription Drug Plans are known as Medicare Part D.

With Medicare Part C, generally, you must use certain doctors, hospitals and pharmacies that are included within a network. To have a Part C plan, you must already have Parts A and B. You will pay your usual Part B premium in addition to what your premium plan will charge.​

Want to learn more? Head over to KFF.org and see the full article.

Have questions? Contact us today!

Curious to see what Plan C plans are available for you in your zip code? Use our plan finder to check out your options.

2020 Medicare Part D Outlook and Beyond

We get it, Understanding Part D prescription drug coverage can get confusing. Especially since deductible amounts and coverage limits can vary year to year. Luckily for you, Medicare advocates can fill you in on all the changes coming to 2020 and beyond.

To understand the changes coming in 2020, let’s take a step back and look at what happened in prior years. According to Q1Medicare.com, from 2016 to 2019 Part D deductibles have risen sporadically, ranging from a $40 increase from 2016 – 2017, to a $5 increase from 2017 – 2018. Our friends at Q1Medicare.com have put together an amazing Part D chart that you can see for your self by clicking here.

So that you can get a better understanding of the changes to 2020 from 2019, we have provided a short preview from Q1Medicare.com

  • Initial Deductible:
    will be increased by $20 to $435 in 2020.
  • Initial Coverage Limit (ICL):
    will increase from $3,820 in 2019 to $4,020 in 2020.
  • Out-of-Pocket Threshold (or TrOOP):
    will increase from $5,100 in 2019 to $6,350 in 2020.

If you would like to learn more about these changes, including the new “Donut Hole Discount,” please click here.

Have questions? Contact us today!