On June 6, 2017, The Henry J. Kaiser Family Foundation published Medicare Advantage 2017 Spotlight: Enrollment Market Update. Written by Gretchen Jacobson and Tricia Newman from the Kaiser Family Foundation, Anthony Damico, an independent consultant, and Marsha Gold, a Senior Fellow Emeritus with Mathematica Policy Research and an independent consultant, the study highlights the fact that “Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade.” The trend in enrollment growth is continuing in 2017, and has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA). The Data Spotlight “reviews national and state-level Medicare Advantage enrollment trends as of March 2017 and examines variations in enrollment by plan type and firm. It also analyzes the most recent data on premiums, out-of-pocket limits, and quality ratings.” The study can be found here.
If you’ve ever gotten a letter from Medicare, you’ve probably found yourself asking two basic questions:
- What does this letter mean?
- What am I supposed to do with it?
Both are good questions.
Since it sometimes feels like Medicare is speaking a foreign language full of three-letter acronyms, we’re here to translate and help you make sense of the letters you receive.
Medicare compliance for P&C insurers can be placed in three big compliance “buckets”:
- Identify all claimants who are Medicare beneficiaries
- Take care of Conditional Payment issues for each Medicare beneficiary identified
- Report each Medicare beneficiary claim to Medicare per Section 111