PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Medicare Part A”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2003

Medicare program; reduction in Medicare Part B premiums as additional benefits under Medicare+Choice plans. Final rule.

This final rule revises the regulations to provide for a Medicare+Choice organization to offer a reduction in the standard Medicare Part B premium as an additional benefit under one or more Medicare+Choice (M+C) plans. The legislation specifies that the reduction to the Medicare Part B premium cannot exceed the standard Medicare Part B premium amount and cannot be applied to surcharges. Surcharges are increased premiums for late enrollment and for reenrollment. The Medicare Part B premium may be collected by a variety of methods: Paid directly to the Centers of Medicare & Medicaid Services by the beneficiary; collected as an adjustment to any Social Security, Railroad Retirement, or Civil Service Retirement benefits; paid by an employer as part of an annuity package; or, paid by the State for individuals enrolled in a qualifying State Medicaid program. This legislation applies to benefits under Medicare M+C plans offered by an M+C organization electing this option, beginning January 1, 2003. This final rule revises the regulations to set out the basic rules under section 606 of the Medicare, Medicaid, and SCHIP Benefits Improvement Protection Act of 2000 (BIPA) for adjustment and payment of the Medicare Part B premium.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Alternatives to traditional Medicare: Medicare Part C poised to prosper.

Recent events indicate that Medicare Part C (Medicare Advantage) plans are poised to prosper. Yet many employers express hesitation to offer Medicare Advantage, formerly known as Medicare+Choice, plans to their retirees because they are concerned about the potential withdrawal of those plans if there is a reversal of federal funding rules. This article addresses those concerns. It provides a historical overview of Medicare Part C and describes the impact of the most recent agency guidance. The author cites plan trends, raises employer implications and concludes that Medicare Advantage plans will continue to expand, possibly facilitated by employers as they implement leading-edge retiree medical designs.

Health Benefit Plans, Employee↗
PubMed2006

Falling into the doughnut hole: drug spending among beneficiaries with end-stage renal disease under Medicare Part D plans.

The Medicare Part D prescription drug benefit may facilitate provision of medications by subsidizing drug costs. However, beneficiaries with higher drug utilization may face higher out-of-pocket (OOP) costs under the benefit's "doughnut hole" provisions that substantially increase beneficiary cost-sharing. The Medicare Current Beneficiary Survey Cost and Use data for 1997 through 2001 were used to estimate the impact of the standard Part D benefit on drug expenditures. The sample consisted of adults who were not dually enrolled in Medicaid (41,617 without ESRD, 256 with ESRD). Outcomes were annual total and OOP drug spending projected to 2006, as well as estimates of individual spending changes under Part D. In 2006, ESRD beneficiaries will have mean annual total and OOP expenditures that are approximately twice that of their Medicare peers. The overall impact of Part D on OOP expenditures is similar among all beneficiaries; however, many individuals with employer-sponsored coverage and those with higher costs (especially those with ESRD) may face cost increases with significant monthly variability as a result of reaching the "doughnut hole," a no-coverage gap in the standard benefit. Therefore, ESRD beneficiaries face substantial total and OOP annual expenditures for medications, causing most to reach the Part D benefit gap. Higher OOP costs may lead to reductions in spending and medication use with subsequent treatment gaps that may lead to increased use of medical services. As the new legislation takes effect, policy makers who are considering modifications in the program may benefit from further research to monitor patterns and gaps in coverage, medication use and spending, and hospitalization and survival trends.

Aged↗
PubMed2006

Implications of Medicare Part D in CKD anemia treatment.

Treating chronic kidney disease (CKD) anemia successfully requires not only making the correct diagnosis and choosing the appropriate treatment but also taking the steps needed to ensure that residents have access to treatment. This can be challenging with regard to the erythropoiesis-stimulating proteins (ESPs). To ensure access to these products, physicians must be health insurance literate, knowing how different Medicare parts cover the erythropoietin (EPO) products. For example, Medicare Part A places the responsibility for medications on the provider. This means that a long-term care facility is responsible for covering the cost of medications used during the Medicare Part A skilled stay. Medicare Part B covers medications that are provided "incident to" a physician service, including injectables provided by physicians in their offices or during dialysis treatments. Managed care plans, which provide coverage under Medicare Part C, are responsible for all of the benefits available under Medicare Parts A and B. The newest Medicare Part is D, the prescription drug benefit introduced in January 2006. Medicare Part D covers most medications administered to residents in a long-term care facility. For the dually eligible-that is, residents covered by both Medicare and Medicaid-the Medicare Part D program replaces Medicaid drug coverage. Unfortunately, the criteria by which these prescription plans choose to cover products such as ESPs are not based on any specific standard but vary greatly by plan as each has the right to determine coverage criteria. In addition to individualized plan criteria, each plan defines its own process for prior authorization, appeals, and exceptions. Understanding the basic rules of coverage is essential to ensuring access to the ESPs for residents with anemia of CKD.

Anemia↗
PubMed2006

The use of disease-modifying agents among multiple sclerosis patients enrolled in medicare from 1995 to 2002 and the impact of medicare part D: analysis of claims data from the medicare current beneficiary survey.

OBJECTIVES: The goals of this analysis were as follows:(1) identify the prevalence of access barriers to disease-modifying agents (DMAs) used in the United States for the treatment of multiple sclerosis (MS), (2) identify the relationship between patient characteristics and use of DMAs, and (3) interpret the results in the context of Medicare Part D. METHODS: Using claims data from the Medicare Current Beneficiary Survey (MCBS) 1992 to 2001, we identified beneficiaries with a diagnosis of MS on > or =4 claims. To adapt for the bimodality of the claims distribution and to capture the majority of MS claims, > or =4 claims were used. We estimated the mean out-of-pocket price of prescription medications and prevalence of perceived economic barriers to address the hypothesis that the expansion of Medicare to include an out-patient drug benefit will decrease beneficiaries' burden of MS. RESULTS: A total of 416 patients with MS were identified with the MCBS claims data. Furthermore, data for 3 DMAs used to manage MS were available: interferon beta-1b, interferon beta-1a, and glatiramer acetate. Data were available for interferon beta-1b for the years 1995 to 2002, and for interferon beta-1a and glatiramer acetate for the years 1999 to 2002. The mean out-of-pocket price per prescribing event (typically 30 days) for interferon beta-1b was US $44.40 from 1995 to 1998 and US $15.08 from 1999 to 2002. Between 1999 and 2002, the mean out-of-pocket price per prescribing event for interferon beta-1a was US $84.74; for glatiramer acetate during the same period, it was US $114.90. Assuming complete compliance for the year, the mean out-of-pocket burden per patient for each medication using the 1999-to-2002 numbers would be US $1016.88 for interferon beta-1a, US $548.91 for interferon beta-1b, and US $1378.80 for glatiramer acetate. The annual prevalence of use of any DMA increased from 6.5% during the years 1995 to 1998 to 21.2% during the years 1999 to 2002. CONCLUSIONS: Our findings suggest that these MS patients, who were Medicare beneficiaries, faced considerable economic barriers to necessary health care, particularly prescription medications. Substantial differences existed in the out-of-pocket prices of DMAs between the 2 time periods analyzed. These differences could be expected to be attenuated by the expansion of Medicare to include a drug benefit (Part D), which will increase insurance coverage for DMAs and reduce the out-of-pocket burden of MS therapies.

Antirheumatic Agents↗
PubMed2007

Overview of Medicare Part D prescription drug benefit: potential implications for patients with psychotic disorders.

PURPOSE: Medicare Part D prescription drug benefits are reviewed. Potential implications for patients with psychotic disorders in relation to Medicare Part D are discussed. SUMMARY: The newly created Medicare Part D provides prescription drug benefits to many individuals formerly without prescription benefits and, possibly, lower-cost benefits to those who previously relied on other benefits. Participating prescription plans use a variety of pharmacy management tools to minimize costs while providing benefit plans that meet Part D requirements for composition and coverage. Patients then have the challenge of choosing a prescription drug plan that will best satisfy their prescriptions needs. CONCLUSION: The rollout of Part D has not been without problems, and although more Medicare participants are receiving prescription drug benefits at a greater savings, there are concerns that Part D may not provide adequate coverage for all patients or for patients requiring certain types of medications, especially some psychotropic medications. Pharmacists have voiced concerns about the Medicare Part D drug plan in regard to both the degree of coverage it provides to enrollees and the difficulty in administering the benefit.

Aged↗
PubMed2006

Lessons for Medicare Part D in the hemodialysis community.

BACKGROUND: Medicare beneficiaries without prescription drug coverage consistently fill fewer prescriptions than beneficiaries with some form of drug coverage due to cost. ESRD patients, who are disproportionately poor and typically use multiple oral medications, would likely benefit substantially from any form of prescription drug coverage. Because most hemodialysis patients are Medicare-eligible, they as well as their providers would be expected to be well informed of changes in Medicare prescription drug coverage. By examining the level of understanding and use of the temporary Medicare Prescription Drug Discount Card Program in the hemodialysis population, we can gain a better understanding of the potential long-term utilization for Medicare Part D. METHODS: We surveyed English-speaking adult hemodialysis patients with Medicare coverage from two urban hemodialysis centers affiliated with the University of California San Francisco (UCSF) during July and August 2005 (n = 70). We also surveyed University- and community-based nephrologists and non-physician dialysis health care professionals over the same time frame (n = 70). RESULTS: Fifty-nine percent of patients received prescription drug coverage through Medi-Cal, 20% through another insurance program, and 21% had no prescription drug coverage. Forty percent of patients with no prescription drug coverage reported "sometimes" or "rarely" being able to obtain medications vs. 22% of patients with some form of drug coverage. None of the patients surveyed actually had a Medicare-approved prescription drug card, and of those who intended to apply, only 10% reported knowing how to do so. Only 11% health care professionals knew the eligibility requirements of the drug discount cards. CONCLUSION: Despite a significant need, hemodialysis patients and providers were poorly educated about the Medicare Prescription Drug Discount Cards. This has broad implications for the dissemination of information about Medicare Part D.

Adult↗
PubMed2006

Medicare Part B income-related monthly adjustment amount. Final rules.

We are adding to our regulations a new subpart, Medicare Part B Income-Related Monthly Adjustment Amount, to contain the rules we will follow for Medicare Part B income-related monthly adjustment amount determinations. The monthly adjustment amount represents the amount of decrease in the Medicare Part B premium subsidy, i.e. the amount of the Federal Government's contribution to the Federal Supplementary Medical Insurance (SMI) Trust Fund. This new subpart implements section 811 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization Act or MMA) and contains the rules for determining when, based on income, a monthly adjustment amount will be added to a Medicare Part B beneficiary's standard monthly premium. These final rules describe: What the new subpart is about; what information we will use to determine whether you will pay an income-related monthly adjustment amount and the amount of the adjustment when applicable; when we will consider a major life-changing event that results in a significant reduction in your modified adjusted gross income; and how you can appeal our determination about your income-related monthly adjustment amount.

Humans↗
PubMed1993

Accuracy of coding in Medicare part B claims. Cataract as a case study.

We studied the accuracy of Medicare part B coding for cataract extraction to provide validation for research involving Medicare data. Hospital and physician office records associated with a sample of 802 paid claims for cataract surgery were reviewed. The sample was randomly selected from 118,420 Medicare part B claims for cataract surgery submitted by physicians in an 11-state sample during the first quarter of 1988. Medical records were successfully obtained for 796 cataract surgery episodes (99.2%), of which 794 (99.7%) indicated that cataract extraction had been performed. In the remaining two cases, cataract surgery was attempted but aborted. In 24 (3%) of the 794 cases, the surgical approach (intracapsular or extracapsular) indicated in the operative note differed from the coded on the physician's bill. In all cases in which the operative note indicated a secondary procedure performed at the time of surgery, the billing information was in agreement. We conclude that, at least in the case of cataract surgery, the Medicare part B database is 99% accurate (95% confidence interval, +/- 0.6%) for cataract surgery having occurred and 96% accurate (95% confidence interval, +/- 1.4%) in terms of surgical approach.

Cataract Extraction↗
PubMed2006

Medicare Part D: practical practice information for healthcare providers.

PURPOSE: To provide an overview of Medicare Part D and useful practice information for healthcare providers to help guide Medicare beneficiaries when choosing a Part D plan. DATA SOURCES: Documents written by the Centers for Medicare & Medicaid Services, Kaiser Family Foundation, and United States Department of Health & Human Services. CONCLUSIONS: Although Medicare Part D can provide assistance with prescription drug costs to Medicare beneficiaries, the transition to Medicare Part D in 2006 will be challenging for both beneficiaries and healthcare providers. It is important that both Medicare beneficiaries and healthcare providers understand the complex drug benefit to facilitate the transition to Medicare Part D. IMPLICATIONS FOR PRACTICE: It is likely that Medicare Part D formularies will require adjustments to many Medicare beneficiaries' medication regimens. Additionally, it is possible that there will be an increase in the number of prior authorizations and other requirements such as step therapy requests.

Choice Behavior↗
PubMed2006

Beyond the subsidy: Medicare Part D employer options.

The Medicare Modernization Act, now more than a year old, is opening up an array of possibilities for employers in dealing with retiree medical benefits. Many employers are beginning to look beyond the question of whether to accept Medicare's prescription drug subsidy and are more broadly considering how to shape their retiree health plans. This article describes the options available to employers now that Medicare Part D is in place. Through this analysis, the authors also explain how the choices employers make could affect retiree medical benefits and workforce planning issues.

Choice Behavior↗
PubMed2006

Economics of critical care: Medicare part A versus part B payments.

OBJECTIVE: To review the effect of Medicare part A payments (to hospitals) and part B payments (to providers) on critical care in the United States. DATA SOURCE AND SELECTION: Sources included U.S. government data and published literature reviewing the impact of Medicate payments on critical care. DATA EXTRACTION AND SYNTHESIS: Government data were reviewed to assess the history and status of reimbursement to hospitals and healthcare providers. These data, along with input from published literature, was used to assess the adequacy of current and projected Medicare reimbursements and the implications of these payments. CONCLUSION: Medicare payments to hospitals, particularly for critically ill patients, seem to fall short of the costs of caring for these patients. Reimbursements to providers seem more encouraging, although the opportunity exists to improve in this area as well.

Critical Care↗
PubMedDate not supplied

Assessing the impact of coverage gaps in the Medicare Part D drug benefit.

The new Medicare Part D drug benefit contains major coverage gaps for people who spend moderate to high amounts on prescription drugs who qualify only for the standard coverage. To help policymakers understand the impact such gaps will have on those affected, we studied a representative sample of Medicare beneficiaries with naturally occurring prescription benefit gaps between 1998 and 2000 using data from the Medicare Current Beneficiary Survey. Our findings suggest that discontinuities in drug benefits result in sizable reductions in medication use and spending, which is magnified in people with common chronic illnesses.

Aged↗