Medicare and Medicaid (BenefitsLink.com)Headlines re Medicare and Medicaid, gathered by BenefitsLink.comThe Effect of Medicare Part D on Pharmaceutical Prices and Utilization- (Found July 5, 2008 ) Excerpt: "This paper evaluates the effect of this program on the price and utilization of pharmaceutical treatments. Theoretically, it is ambiguous whether the expansion in insurance coverage would increase or reduce pharmaceutical prices. Insurance-induced reductions in demand elasticities would predict an increase in pharmaceutical firms' optimal prices. However, Part D plans could potentially negotiate price discounts through their ability to influence the market share of specific...http://papers.nber.org/papers/w13917 Opinion Social Security - Still Alive and Kicking- (Found July 5, 2008 ) Excerpt: "This year, as happens every year, when the Trustees' Report on Social Security and Medicare is released, commentators seized on the forecasts to proclaim imminent disaster and called for privatization of Social Security. In fact, the official forecasts, released yesterday, differ only marginally from those of 2007. The report underlines that we need to solve problems in these safety net programs. But there is no imminent Social Security crisis; in fact, the outlook is marginally..http://takingnote.tcf.org/2008/03/social-securi-1.html Trends in Medigap Policies, December 2004 to December 2006 (PDF)- (Found July 5, 2008 ) 7 pages. Excerpt: "This paper presents findings from an analysis conducted by America's Health Insurance Plans (AHIP) on enrollment trends in Medicare Supplement (Medigap) insurance coverage, using year-end data for 2004 through 2006 from the National Association of Insurance Commissioners (NAIC). The NAIC dataset contains information on most Medigap policies in force in the U.S.,1 representing approximately 10 million covered lives with policies from nearly 250 carriers." (Americas...http://www.ahipresearch.org/pdfs/MedigapTrendReport.pdf Medigap: What You Need to Know (PDF)- (Found July 5, 2008 ) 12 pages. Excerpt: "This policy brief presents a snapshot of private Medicare Supplement (Medigap) insurance in 2008. Changes in Medigap products and expanded Medicare private plan options established by the Medicare Modernization Act of 2003 (MMA) became effective January 1, 2006. While most of the traditional standard Medigap products are unchanged, in conjunction with making the new Medicare (Part D) prescription drug benefits available, the MMA prohibited the inclusion of prescription..http://www.ahipresearch.org/pdfs/MedigapWhitePaper.pdf Guidance Overview Plans Required to Reimburse Medicaid Even if Participant Failed to Obtain Required Preauthorization for Services- (Found July 5, 2008 ) Excerpt: "EBIA Comment: This opinion builds on Advisory Opinion 2005-05A, in which the DOL concluded that ERISA does not preempt state laws that authorize states to recoup Medicaid payments from a plan if the plan would have been liable to any third party before the Medicaid payment was made . . . . According to that advisory opinion, such state laws may be enforced 'notwithstanding the plan's procedural requirements governing participant benefit claims' (for instance, Medicaid does not...http://www.ebia.com/weeklyguest/19355/2008050208f9770b01b8a984a12124902d1ac670/BNL080410 Boomers to Flood Medical System, According to Study- (Found July 5, 2008 ) Excerpt: "The report from the Institute of Medicine, an arm of the National Academy of Sciences, said: --There aren't enough specialists in geriatric medicine. --Insufficient training is available. --The specialists that do exist are underpaid. --Medicare fails to provide for team care that many elderly patients need." (AP via The New York Times; free registration required)http://www.nytimes.com/aponline/us/AP-Elder-Care.html?scp=2&sq=health&st=nyt Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings (PDF)- (Found July 5, 2008 ) 7 pages. Excerpt: "This synthesis of key findings from analysis presented in a series of eight Medicare Part D 2008 Data Spotlights describes key features of stand-alone prescription drug plans offered in 2008 and trends since 2006. The synthesis covers a range of topics, including premiums, the coverage gap, benefit design, cost sharing, specialty tiers, formularies, utilization management, the top 10 brand-name prescription drugs, and the availability of low-income subsidy plans."...http://www.kff.org/medicare/upload/7762.pdf Guidance Overview Coordinating Retiree Health Benefits with Medicare (PDF)- (Found July 5, 2008 ) 2 pages. (Milliman)http://www.milliman.com/expertise/employee-benefits/publications/cab/pdfs/CAB03-28-08-EEOC... Official Guidance DOL Advisory Opinion 2008-03A on ERISA Preemption- (Found July 5, 2008 ) Excerpt: "Whether ERISA would preempt an action by a State Medicaid Agency to recover Medicaid benefit payments made on behalf of individuals who are also participants in ERISA-covered private health insurance plans that require prior authorization for covered health care items or services." (U.S. Employee Benefits Security Administration)http://www.dol.gov/ebsa/regs/aos/ao2008-03a.html Congress Considers Medicare Legislation- (Found July 5, 2008 ) Excerpt: "Medicare and Medicaid legislation has seen considerable debate this legislative session. The Medicare, Medicaid and SCHIP Extension Act of 2007 (S. 2499) delayed scheduled cuts in physician reimbursements for six months, reauthorized the State Children's Health Insurance Program (SCHIP) for 18 months and required employer-provided health plans to provide enrollment data to the secretary of Health and Human Services . . . ." (Watson Wyatt Worldwide)http://www.watsonwyatt.com/us/pubs/insider/showarticle.asp?ArticleID=18877 |