Medicare Advantage Enrollment Officially Crosses 50% of Beneficiaries: KFF
Fierce Healthcare | By Paige Minemyer
It's official: Medicare Advantage (MA) enrollment accounts for just over half of all Medicare beneficiaries, according to a new analysis from the Kaiser Family Foundation.
KFF researchers analyzed data from the Centers for Medicare & Medicaid Services and found that 30.19 million of the 59.82 million people enrolled in Medicare as of January 2023 were in an MA plan, the first time the program has crossed 50% of all Medicare enrollment.
Medicare Advantage has grown at a steady clip since its inception. Enrollment in private Medicare plans accounted for just 19% of the program in 2007, according to KFF. By 2019, enrollment had doubled to 39%.
"Enrollment in Medicare Advantage has increased dramatically in recent years," the KFF analysts wrote. "The growth in enrollment is due to a number of factors, including the attraction of extra benefits offered by most plans, such as vision, hearing, and dental services, and the potential for lower out-of-pocket spending, particularly compared to traditional Medicare without supplemental coverage."
In addition, MA coverage is attractive to many as it provides a one-stop shop for beneficiaries, since they will not need to shop separately for Part D coverage or supplemental plans, the researchers added.
The rapid growth has made MA a central focus for insurers, who generate significant profit in this space. Enrollment nationally is dominated by UnitedHealthcare and Humana.
That expansion has also led to far greater scrutiny on how insurers are managing the program along with concern that they're pocketing excessive dollars as MA grows. There is also a dearth of data on how MA compares to traditional Medicare in managing equity challenges and reaching underserved patient populations, the KFF researchers said.
Critics are also concerned about utilization management in the program, and the KFF report said that in 2021 alone MA members submitted 35 million requests for prior authorization.
"As the role of Medicare Advantage grows, so will interest in understanding how well the program serves the increasingly diverse group of enrollees who receive their Medicare coverage from private insurers," the KFF researchers said. |
Updates to Coverage for COVID-19 Tests
The COVID-19 Public Health Emergency is to end on May 11, 2023. The ending of the Public Health Emergency may impact an individual’s coverage of COVID-19 tests. We encourage you to know these changes and share the New Consumer Fact Sheet on COVID-19 tests.
Consumer Fact Sheets:
Before May 11, 2023
If you have any type of health insurance, you can get up to eight over-the-counter tests per month with no out-of-pocket costs. Over-the-counter tests are available in most pharmacies and may also be available online for delivery.
After May 11, 2023
Laboratory tests for COVID-19 that are ordered by your provider will still be covered with no out-of-pocket costs for people with Medicare. Over-the-counter tests will still be available, but there may be out-of-pocket costs. Coverage of over-the-counter tests may vary by your insurance type, as described below.
What does this mean for Medicare Beneficiaries?
Generally, Medicare doesn’t cover or pay for over-the counter products. The demonstration that has allowed us to offer coverage for COVID-19 over-the-counter tests at no cost ends on May 11, 2023.
However, if you are enrolled in Medicare Part B, you will continue to have coverage with no out-of-pocket costs for appropriate laboratory-based COVID-19 PCR and antigen tests, when a provider orders them (such as drive-through PCR and antigen testing or testing in a provider’s office).
If you are enrolled in a Medicare Advantage plan, you may have more access to tests depending on your benefits. Check with your plan.
What does this mean for people with Medicaid or Children’s Health Insurance Program?
If you have coverage through Medicaid or the Children’s Health Insurance Program, you will have access to COVID-19 over-the-counter and laboratory testing through September 30, 2024. After that date, coverage of testing may vary by state.
What does this mean for people with Private Insurance?
If you have private insurance, coverage will vary depending on your health plan. However, private plans won’t be required by federal law to cover over-the counter and laboratory-based COVID-19 tests after May 11, 2023.
If your insurance chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management. |
Study Offers Fresh Hope for People Living with Chronic Back Pain
By Curtin University
Long-term sufferers of chronic back pain experienced dramatic reductions in pain and related disability that remained at their one-year follow-up after taking part in a new treatment tested by Curtin-Macquarie-Monash University research.
Published today in the journal The Lancet, the research found large clinically significant improvements in the intensity of pain and pain-related disability among almost 500 people who had been seeking help for their pain for an average of four years before trialing the new treatment.
The treatment, which delivered a health care and work productivity saving of more than $5,000 per person, took a whole-person approach by also helping people to make lifestyle changes aimed at improving their social and emotional health.
Lead author Associate Professor Peter Kent, from the Curtin School of Allied Health, said the findings produced compelling evidence that the new treatment had a large and lasting impact at a "clinically important" level.
"Lower back pain is the leading cause of disability across the globe, contributing to a loss of work productivity and early retirement worldwide," Associate Professor Kent said.
"These exciting results give hope to the millions of people around the world who are disabled by back pain. It also provides a clear roadmap for clinicians, health services and policymakers on how to reduce the growing burden of chronic back pain with a high-value, low-risk approach based on the best scientific evidence."
The treatment, called Cognitive Functional Therapy (CFT), offered personalized and intensive coaching sessions that helped people make sense of their pain, focused on retraining them to move in ways that reduced their pain, and built confidence in movements and activities they had been afraid of or were avoiding. The treatment was delivered in 20 clinics across Perth and Sydney by 18 physiotherapists that were specifically trained to deliver CFT.
Participants living with chronic back pain—including many who had high levels of disability—tested the program in up to seven sessions over a 12-week period, followed by a booster session at six months. They were followed-up by questionnaires until 12 months. More than 80 percent of the participants were satisfied with the treatment.
Co-author Professor Peter O'Sullivan, also from the Curtin School of Allied Health, who developed the new treatment, said it put the patient at the center of care.
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New Insights into the Brain’s Motor Cortex
National Institutes of Health
The brain’s primary motor cortex is a thin band of nerve cells and circuits that extends from the top of the head and downward on both sides. It’s long been thought to have a straightforward role as the brain’s command center for voluntary muscle movements, sending out signals that trigger movements in specific body parts. Complex movements were believed to be coordinated by other areas of the brain.
A century ago, a systematic study involved electrically stimulating different human brain areas during surgery to see the resulting body movements. The study revealed a well-organized “body map.” This research led to a familiar drawing of the cortical band that’s taught in biology classrooms to this day. The drawing shows the motor cortex as an orderly continuum from head to toe. One end primarily controls face-related movements, followed by regions that control the hands and then the feet.
In recent decades, studies have questioned this linear body map in the motor cortex. For instance, studies in nonhuman primates suggested that the map may be divided into concentric zones instead of a continuous row. So digits like fingers might be in the middle, surrounded by areas for the wrists, elbows, then shoulders. Other studies found that large portions of the primary motor cortex seemed to prompt no muscle movements at all, but revealed connections to brain areas controlling other functions.
To learn more, a team led by Drs. Evan Gordon and Nico Dosenbach at Washington University in St. Louis used an advanced imaging method called precision fMRI to reexamine the function and organization of the human motor cortex. The technique involved repeatedly scanning each person’s brain over many hours to create high-resolution brain maps for each individual. Results appeared in Nature on April 19, 2023…
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