GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial…

Study ObjectivesWe sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional…

Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS) for enrollees who are sicker, which helps to ensure that plans receive sufficient…

“Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system…

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

GAINING CLARITI: This analysis from KFF highlights the substantial increase in prior authorization requests for Medicare Advantage beneficiaries, exceeding 46 million in 2022. This trend affects skilled nursing facilities as…

In 2024, three quarters (75%) of enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is a big…

From its inception, Medicare Advantage (MA), a program in which private health insurers contract with the Medicare program to provide coverage on a capitated basis, has faced significant criticism that…

Key Takeaways Following acute hospitalization, Medicare Advantage members with orders to receive home health may not ultimately receive these services for member- and health care system–related reasons. Common reasons for…

Chapter 2 looks at the monitoring and oversight of denials and appeals in Medicaid managed care and the beneficiary experience with the appeals process. Beneficiaries appeal few denials, and program…

“Given the lack of available data to describe MA claim denials, increasing transparency is a critical first step. Although the rule requires public disclosure of MA plans’ utilization review criteria,…

The Medicare Advantage (MA) program currently insures half of Medicare beneficiaries, and yet there are major gaps in our understanding of how it is impacting older adults, particularly those with…

The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office called on the Centers for Medicare &…

Three factors raise concerns that some people enrolled in Medicaid managed care may not be receiving all medically necessary health care services intended to be covered: (1) the high number…

Medicare Advantage (MA) plans, which accounted for 45 percent of total Medicare enrollment in 2022, are incentivized to minimize spending on low-value services. Prior research indicates that MA plan enrollment is…

The growing role of Medicare Advantage in the Medicare program and the changing demographics of Medicare Advantage enrollees have given rise to an interest in how well private plans serve…

GAINING CLARITY: This compilation of OIG resources focused on managed care provides a centralized hub for understanding the oversight and compliance landscape related to Medicare Advantage plans, which play an…