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CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes

On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in areas including network adequacy, beneficiary protections, quality oversight, and rates and payment.

Medicare Open Enrollment FAQs

This list of Frequently Asked Questions (FAQs) about Medicare Open Enrollment covers a range of topics related to Medicare enrollment, Medicare Advantage, Part D, Medigap, employer/retiree coverage, Medicaid and other low-income assistance, Medicare and the Marketplaces, and more.

Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic

This brief provides an overview of how Medicaid managed care organization (MCO) capitation rates are developed by states and approved by CMS, highlights options available to states to adjust current rates and/or risk sharing mechanisms, describes how MCOs pay providers, and outlines state options to direct MCO payments to providers in response to conditions created by the COVID-19 pandemic.

When Is the Open Enrollment period for Medicare?

The Medicare Open Enrollment period runs from October 15 through December 7 each year. During this period, people on Medicare have the opportunity to make a change in their coverage. If you are covered by Medicare, and you are interested in reviewing and comparing your Medicare coverage options, make sure…

I have Medicare Part A and Part B. I’ve heard about Part C and Part D, but I don’t know what those are. Do I need to sign up for those during the Medicare Open Enrollment period?

Medicare Part C plans, also known as Medicare Advantage plans, are private health insurance plans, mainly HMOs and PPOs, for people enrolled in Medicare. If you enroll in a Medicare Advantage plan, you still have Medicare, but you get all of your Medicare-covered benefits through a private plan. Most Medicare…

I live alone without family or close friends nearby, and I don’t have a computer. Where can I get help learning about the Medicare drug plans and Medicare Advantage plans in my area?

You can learn about your coverage options by calling 1-800-MEDICARE (1-800-633-4227), or by speaking with someone at your local State Health Insurance Assistance Program (SHIP). SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the…

Can I change my Medicare coverage outside of the Medicare Open Enrollment period?

You can, but generally only under special circumstances that qualify you for a Special Enrollment Period (SEP). These circumstances include (but are not limited to) moving to a new location that is outside of your current plan’s service area or where additional plan options are available, moving back into the…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.