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Decoding Medicare Advantage Coding Intensity

Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS, the effects on beneficiaries, and other proposals to improve payment accuracy.

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The Facts About Medicare Spending

This interactive provides the facts on Medicare spending. Medicare, which serves 67 million people and accounts for 12 percent of the federal budget and 21 percent of national health spending, is often the focus of discussions about health expenditures, health care affordability and the sustainability of federal health programs. Explore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending by beneficiaries.

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  • Can I receive extra benefits from a Medicare Advantage plan that I wouldn’t be able to get in traditional Medicare?

    FAQs

    Yes, Medicare Advantage plans can offer extra benefits that are not offered in traditional Medicare. For example, Medicare Advantage plans may offer dental coverage or a fitness benefit to those enrolled. Medicare Advantage plans can also offer benefits that are not directly health-related, like meal delivery services. Medicare Advantage plans may require an additional monthly premium for some of these supplemental benefits, such as dental coverage. Although Medicare Advantage plans can offer extra benefits, they…

  • Hay muchas opciones de la Parte de D de Medicare en mi área. ¿Cómo decidir cuál es el mejor plan para mí?

    FAQs

    Hay dos formas de obtener cobertura de medicamentos. Si tiene Medicare tradicional, puede inscribirse en un plan de medicamentos recetados independiente. O puede inscribirse en un plan Medicare Advantage que cubra todos sus beneficios de Medicare, incluido el de medicamentos recetados. Cualquiera que elija, sus costos y cobertura pueden variar de un plan a otro. Al elegir la cobertura de medicamentos que mejor se adapte a sus necesidades, puede comparar las primas de los planes,…

  • I am covered by Medicare, but I don’t take any medications. Do I need to sign up for a drug plan?

    FAQs

    Even if you aren’t taking any medications right now, it makes sense to enroll in a drug plan so that you have coverage in case your needs change in the future. If you don’t have coverage and the Medicare Open Enrollment period has ended, you won’t be able to sign up for coverage until the next Medicare Open Enrollment period begins, and your coverage wouldn’t take effect until January 1 of the following year. This…

  • There are a lot of Medicare Part D plan options in my area. How do I decide which plan is best for me?

    FAQs

    There are two ways you can get drug coverage. If you have traditional Medicare, you can sign up for a stand-alone prescription drug plan. Or you can join a Medicare Advantage plan that covers all your Medicare benefits including the prescription drug benefit. Whichever you choose, your costs and coverage can vary from one plan to another. In picking the drug coverage that best meets your needs, you can compare plan costs for the premium,…

  • Can I be charged a higher premium for Medicare Part D plans if I have a pre-existing condition or if I smoke?

    FAQs

    No. Part D plan premiums are not allowed to vary depending on your age, health status, whether you have pre-existing conditions, or are a smoker. The monthly premium that any given Part D plan charges is the same for any beneficiary who chooses to enroll in that plan. If your income is over a certain level, you may be required to pay a higher premium. If you have a relatively low income and limited assets,…

  • What is Medigap?

    FAQs

    Medicare supplement insurance policies, or Medigap policies, help to pay the copayments, coinsurance, and deductibles for Medicare-covered benefits under traditional Medicare (Part A and Part B services). Some Medigap policies also cover services that traditional Medicare does not cover, such as medical care when you travel outside the country. Medigap policies do not work with Medicare Advantage plans and will not help to cover Medicare Advantage enrollees’ out-of-pocket costs.

  • I have Medigap and I’m finding it difficult to afford. What are my other options for supplemental coverage?

    FAQs

    You may want to find out if you qualify for Medicaid, if your income and assets are low enough. Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements, and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. To find out if you qualify, you can contact the State Medical Assistance Office or the State Health Insurance Assistance Program…

  • I am 66 years old, work for a large employer, and have health insurance coverage through my job. I am planning to keep working for a few more years and keep the coverage that my employer offers. What ar...

    FAQs

    When you stop working and/or your group health insurance coverage ends, you should enroll in Medicare Part A and Part B. If you’re eligible for premium-free Part A, you can sign up any time after you’re first eligible for Medicare. Your Part A coverage will go back retroactively 6 months from when you sign up (but no earlier than the first month you were eligible). You have an 8-month Special Enrollment Period (SEP) to enroll…

  • If my employer offers retiree health benefits, do I need to sign up for Medicare when I turn 65?

    FAQs

    For most people with retiree health benefits, it makes sense to sign up for Medicare when you are first eligible to do so. Retiree health plans are typically designed to supplement Medicare, and might not pay your medical costs during any period that you were eligible for Medicare but not signed up for it. You should review any information provided by your employer to be sure you understand how your retiree health benefits coordinate with…