Veteran enrollment in Medicare Advantage has grown significantly in recent years with regulatory changes increasing its value and flexibility. PEPReC explores whether these changes impacted reliance of VHA services.
With Medicare’s Open Enrollment period approaching, the State Health Insurance Assistance Program (SHIP) can provide free, unbiased health-insurance counseling to help beneficiaries’ decision-making process.
What are Medicare Advantage enrollees getting when they buy into a broader or narrower network plan?
The differences across Medicare Advantage plan types in access to and cost sharing for out-of-network providers leads to the important question, do their provider networks vary by plan within contract?
As is the case with almost every facet of the healthcare system, MA plans still have a lot of work to do in addressing health equity.
After decades of growing pains, Medicare Advantage continues to expand no matter the political party of the sitting president, but how much growth and whom that growth most benefits — consumer or insurer — depends on which policy levers that administration pulls.
The complexity of Medicare Advantage (MA) physician networks has been well-documented, but the payment regulations that underlie these plans remain opaque, even to experts. If an MA plan enrollee sees an out-of-network doctor, how much should she expect to pay?
Moving the needle on upcoding will require a multifaceted approach, dependent on both regulatory oversight and buy-in from payers and providers.
Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary.
Medicare Advantage are plans with private companies that contract with Medicare to deliver services. Some of these plans work great, but many of them have
The following originally appeared on The Upshot (copyright 2019, The New York Times Company). I also appeared on page B4 of the print edition on July
Gilbert Benavidez is a Policy Analyst with Boston University’s School of Public Health. He tweets at @GBinsolidarity. A slightly earlier version of this piece is cross-posted
Work posted here under copyright © of the authors • Details on the Site Policies page
