Part B Premiums Same for 2009
Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, CMS actuary, said during a briefing. For Medicare Part A, the deductible—which covers the first 60 days of Medicare beneficiary's hospital stay, will rise to $1,068 next year, an increase of $44.
Part D Marketing Rules Finalized
CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the new regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.
Part D Premiums Up $3 a Month
Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said, adding that CMS is encouraging beneficiaries to examine their options and review their plans before making a decision for next year.
Retail Clinics Reach Underserved
Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same 10 clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.
CMS Alters Overpayment Policy
CMS officials are changing the procedures for recovering certain overpayments made to physicians. CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, Hospice Caps calculations, provider-initiated adjustments, Home Health Agency Requests for Anticipated Payment, Accelerated/Advance Payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to CMS.