June Medicare Must-Knows

By RetireMEDiQ

RetireMEDiQ strives to keep individuals informed about the latest Medicare news. Each month, we recap the top information consumers need to know about recent developments in the Medicare industry and how it may affect you.

What’s Next for Nursing Homes Post-Pandemic?

Across the nation, nursing home providers and regulators are being challenged as the impact of coronavirus on nursing homes is released. More than 60,000 people in nursing homes contracted COVID-19, more than 26,000 residents died; similarly, more than 34,000 staff got sick and nearly 450 staff members died of COVID-19. Nearly 80 percent of nursing homes have submitted data about the impact of COVID-19 in their buildings, and data shows that nursing homes with the lowest ratings (1 or 2 stars in the government’s 5-star rating system) fared worse than their 4 and 5-star counterparts. Of all nursing homes reporting in, nearly 1 in every 4 facilities had at least one COVID-19 case and 1 in 5 facilities reported at least one death. These numbers are expected to increase as more nursing homes supply data as requested by the Centers for Medicare and Medicaid Services. The data does not yet include assisted living facilities. Medicare and Medicaid Administrator Seema Verma indicated that while hand-washing continues to be a challenge in nursing homes, many facilities exhibited signs of disease control prior to the coronavirus outbreak.

Coverage Expanded Under Medicare Advantage Plans.

The Centers for Medicare and Medicaid Services (CMS) have finalized telehealth policies and supplemental chronic disease management benefits covered under Medicare Advantage  plans. In addition, CMS also expanded coverage options for beneficiaries in rural locations and those with end-stage renal disease care under Medicare Advantage. As states continue to urge vulnerable populations, including individuals over age 65, to stay home as a preventive measure to limit exposure to COVID-19, the final policies enable more individuals to receive needed care from the comfort of their homes. The most recent expansion allows for certain specialty providers, like dermatologists and psychiatrists, to offer their services via telehealth platforms rather than in-person appointments. The telehealth expansion has been well received, as Medicare Advantage members report high levels of satisfaction with their telehealth experiences. In addition, CMS’ final rule includes an expansion of Medicare Advantage eligibility to all Medicare beneficiaries with end-stage renal disease beginning January 1, 2021. 

Part D Seniors Savings Model Caps Insulin Copay to $35

In May, CMS announced that more than 1,750 Medicare Advantage Prescription Drug (MAPD) and Medicare Advantage  (MA) plans have applied to offer lower insulin costs through the Part D Senior Savings Model. Beginning in 2021, beneficiaries could see insulin copays capped at $35 for a month’s supply. Currently, beneficiaries are responsible for 25% of a drug’s cost in the coverage gap that exists between the cost of the medication and the benefit of the plan. Depending on the particular phase of a Part D plan, a beneficiary may see fluctuations in their monthly bill for the same medication. The Part D Senior Savings Model aims to address this problem, among other issues, by setting a high-end limit to $35 for the monthly medication copay. According to CMS, “beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446, or 66 percent.” More information about the Part D Senior Savings Model is available here.  

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