Insurance

Seniors need to examine insurance plans carefully to avoid devastating financial surprises. It's not easy, though, as insurance becomes increasingly complex with sometimes widely disparate rules for various scenarios.

The debt ceiling has been raised, and that means that the government will be looking for ways to control long-term budget expenditures, including those for programs like Medicare.

As the dust settled following yesterday's last-minute budget deal to avert a federal government's default, a frightening fact emerged for the nation's doctors.

Dual eligibles-the class of Americans that qualify for both Medicaid and Medicare coverage-are mostly older adults with low incomes and tend to be the sickest beneficiaries covered by either Medicaid or Medicare.

Almost all pharmacy and therapeutic committees have a unique process for evidence-based formulary decision making, said Steven Pearson, MD, founder & president, Institute for Clinical and Economic Review.

Edmund J. Pezalla, MD, MPH, national medical director, Aetna Pharmacy Management, suggest that the healthcare industry will continue to move in the direction of providing patients incentives to make use of health risk assessment tools and screenings.

Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, says the federal Medicare program not only has a spending problem, but a delivery system problem that the fee-for-service model has not solved.

Hospitals spend less on operations-largely by squeezing labor costs-to make up for lost revenue when Medicare cuts hospital prices, according to a study.

In five markets around the country, accountable care organizations were providing care to more than half the Medicare patients in the traditional fee-for-service program, a new study found. In addition, ACOs were more likely to be found in markets with greater consolidation by hospitals and doctors.

In the past few years, efforts to lower costs and improve care have proliferated.

There's a Medicare prescription-drug coverage abyss that is playfully referred to as the "doughnut hole," though there is nothing sweet or amusing about it.

As the government shutdown drags on, patients and providers are feeling the strain.

Barry Singer, MD, director, MS Center for Innovations in Care, St. Louis, MO, said that the Affordable Care Act could cause challenges in terms of coverage.

Hospitals will be paid nearly the same rates by health plans sold through new state insurance exchanges as by plans sold to employers outside them, say analysts and hospital system executives.

Medicare officials announced Thursday that they will delay enforcement of controversial new rules that define when hospital patients should receive observation care, rather than being admitted, a distinction that makes beneficiaries ineligible for follow-up nursing home coverage.

Melanie Bella, director, Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, says the sole focus of the Medicare-Medicaid Coordination Office is to increase coordination and access to services from many fronts.

The sweeping federal health care law making its major public debut next month was meant for people like Juanita Stonebraker, 63, from Oakland, Md., who retired from her job in a hospital billing office a year and a half ago.

Federally qualified health centers would receive higher Medicare reimbursements starting next year, under a proposed rule issued by the CMS.

Associations between out-of-pocket costs and prescription reversals, as well as impact of reversals on rehospitalizations and healthcare costs, were examined among patients prescribed oral linezolid.

MedPAC, the Congressional advisory committee on Medicare, discussed how to get patients more involved in their health decisions.

Federal officials for more than a decade have let hospitals charge Medicare varying rates for certain emergency department overhead and staffing costs called facility fees-a controversial policy some critics believe invites overcharges.

Hospitals and healthcare systems nationwide are increasingly buying more physician practices as health reform requires care delivery to move toward a more quality-based care model instead of a fee-for-service one. The reactions are mixed.

Bargaining leverage, not the cost of providing complex care, is the main reason why some hospitals can demand prices twice as high as their competitors' and still get contracts to treat privately insured patients, according to a new study.

A new poll conducted by the American College of Physician Executives has found that doctors are almost evenly divided on whether or not Medicare payment data should be made public.