UPMC Health Plan’s Post

Good luck Grandma. Maybe I'm looking a little less like chicken little after all. At the risk of being a broken record, CMS went too far with HCC v28. Period. I'm not debating whether coding has been egregious here, it's about taking an action that is "too much too soon". I don't think CMS meant to call everyone's bluff but it's unfortunate either way. Because the downstream impact will be on those that don't deserve it. -the 10s of thousands of seniors who rely on their MA plan to manage their healthcare costs who will be left facing the deductibles of Part A & B -the providers who have bravely stepped up to take the insurance risk -the ACOs who will end up suddenly managing a bunch of newly aligned beneficiaries -the hospitals who's ERs will see an influx of seniors who can't afford to see a doctor under FFS and end up withholding needed care -the thousands of people that will lose their jobs as a result And the most ironic of all - the Medicare trust fund that will suddenly be facing an influx of unmanaged Medicare beneficiaries. Hats off to the healthplans (and their leaders) that have decided to fight to improve outcomes enough to stay the course vs. abandoning seniors. Christopher Chen, MD (glad you are back) ChenMed Sachin H. Jain, MD, MBA SCAN Andrew Toy Clover Health and many others I'm inadvertently not crediting...Feel free to tag yourself So maybe CMMI and their value based care programs for FFS Medicare isn't such a bad idea after all... Colby Schaeffer Andrew Schwab Mike Barrett

PPO plan type enrollment increased ~843,000 during AEP (6% increase). How did other Plan Types change? Let's take a look: -> HMO continues to be the largest bucket at 18.4 million, but only grew 1% during AEP -> PFFS, MSA, Medicare-Medicaid, and Cost plans all declined during AEP -> D-SNPs grew 3% (~158,000 members) -> C-SNPs grew 21% (~111,000 members)... This was the "trending" plan type this year -> Part B giveback plans grew 10% (~260,000 members) Note: Enrollment may be duplicated between plan types as the categories above are not exclusive to one another. ___ P.S. -> if you are interested in seeing this for every state go here -> https://lnkd.in/gwH2WeUs

What is the price of switching to PPO? The views are mine. The chart below shows the enrollment numbers for Geisinger Medicare Advantage plans in Luzerne County from January 2021 to January 2024. As can be seen, the total enrollment numbers grew over the years. However, if you look inside, memberships have noticeably changed for 𝗛𝗠𝗢 (𝗖𝗼𝗻𝘁𝗿𝗮𝗰𝘁 𝗜𝗗 𝗛𝟯𝟵𝟱𝟰) and 𝗣𝗣𝗢 (𝗖𝗼𝗻𝘁𝗿𝗮𝗰𝘁 𝗜𝗗 𝗛𝟯𝟵𝟮𝟰) plans. Although there could be completely new PPO members, based on my experience, it is reasonable to assume that many HMO members "switched" to the PPO plan. The Geisinger HMO plan's premium is $0, while its PPO plan charges $65 per month. Of course, other parameters, such as MOOP, differ. If the PPO premium were lower, would more members have switched? Or vice versa? Are those members switching because they can still get the same network of doctors? Would this shift be better for Geisinger? Did Geisinger intend this change? With the $65 premium, would Geisinger be able to keep the profit margin? #valuebasedcare #medicareadvantage #hmo #ppo #healthcareanalytics

Medicare Advantage 2024 Landscape for FL, CA & TX '24 MA Plan Availability, Plan Types, Plan Premiums... ...get the deep dive here: https://lnkd.in/gdqfh2cK

If you have TRICARE, there are things to consider before deciding to enroll in a Medicare Advantage plan. 💭 In our newest blog post, we cover how TRICARE works with Medicare Advantage plans, check it out! https://ow.ly/BgLN50QGgFZ Want to stay up-to-date with Medicare updates? Subscribe to our newsletter! 📰 https://ow.ly/BxRr50QGgG1 #TRICAREandMedicare #TMS

If you have TRICARE, there are things to consider before deciding to enroll in a Medicare Advantage plan. 💭 In our newest blog post, we cover how TRICARE works with Medicare Advantage plans, check it out! https://ow.ly/pjo250QGgFW Want to stay up-to-date with Medicare updates? Subscribe to our newsletter! 📰 https://ow.ly/TpII50QGgG5 #TRICAREandMedicare #TMS

In New York, the Medicaid Asset Protection Trust (MAPT) is a popular estate planning tool. By transferring assets into an irrevocable trust, you relinquish ownership, making them exempt from long-term nursing home Medicaid calculations after a five-year waiting period (for rin-home nursing care, the waiting period is two and a half years). This strategy can protect your assets while allowing you to qualify for Medicaid, if needed and planned in advance.

Starting January 1, 2024, there will be modifications to the Prior Authorization Codes for BCBS TX Medicare Members: What’s Changing: Blue Cross and Blue Shield of Texas is changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association. Changes include: Jan. 1, 2024 – Removal of Magellan Electro Convulsive Therapy codes previously reviewed by BCBSTX The revised lists can be found on the following link https://lnkd.in/gNeFHkqV #medicareadvantage #medicalbillingandcoding #priorauthorization #stayinformed #stayconnected #letsconnect #knowledgesharing #payerupdates #2024vision #bcbs

🔵 Struggling to navigate the complex world of Medicare programs and options? Let MCARE1, Inc. be your guide! Our expert team not only offers comprehensive services like reviewing co-pays and explaining plan limitations, but also provides constant support and thorough plan benefit knowledge. We're here to help you make informed decisions. #MedicareSimplified #MCARE1 #RetirementPlanning #HealthcareSolutions #InformedDecisions

I really enjoyed this discussion with Colin Miller - Founding Partner of Medicare Plan Partners. Colin and his business are focused on Medicare Planning for individuals so this was an opportunity for me to grill Colin on all things Medicare. I am amazed at his knowledge and ability to present information in a manner that is easy to understand and digest. A lot of really good stuff covered, including: -Medicare overview -When do individuals need to enroll in Medicare -Who needs to enroll and who can delay -Different parts of Medicare including Part A, Part B, Part D, and Supplemental Plans -Medicare Advantage Plans -Medicare Part B Premiums -Changes coming to Medicare And more! So if you believe Medicare may be in your future, I strongly encourage you to tune in! #medicareplanning #retirementplanning #listentotheexperts #healthcareinretirement https://lnkd.in/gfzKr9ch