Tag Archives: medicare

Three Reasons Why the Pro-ACA Resistance Should Take Heart

By | December 28, 2017

The Affordable Care Act (ACA) had a roller-coaster of a year.  It began with threats of almost certain repeal, followed by effort after unsuccessful effort to dismantle it. Then in the last days of 2017, there was the successful repeal of the individual mandate and penalty. This was brazen politics, suspenseful and often agonizing.  … Read More »

Risk Selection and Health Outcomes in Private Medicare Plans

By | December 18, 2017

A new study in the January 2018 issue of Medical Care, “Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011” by Dr. Siran Koroukian, et al., finds that while Medicare Advantage private plans continue to benefit from favorable risk selection, Medicare Advantage (MA) enrollees do not have better… Read More »

Falls and the rise of wearable sensors

By | July 27, 2017

“I’ve fallen, and I can’t get up!” Remember that catchphrase of the late 1980s and early 1990s, based on the television commercial for LifeCall? Well, the Mrs. Fletcher of yesterday would be amazed by the wearable devices of today – they might even be able to prevent her fall in the first place! According to… Read More »

Problems with Epilepsy Drug Treatment for Older Adults

By | June 3, 2017

Expensive brand-name drugs are prescribed over older, less costly generics whose efficacy and risk profiles aren’t much different. Sometimes the financial issues involved are painfully obvious, such as when a drug company introduces a new, “improved” version of a medication that is merely a longer-acting version of the same chemical entity shortly before the patent expires on the original… Read More »

How did Part D affect mortality among women with breast cancer?

By | March 2, 2017

Ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played… Read More »

The Person-Centered Wellness Home: Reflections on a Conversation with Dr. Thelma Mielenz

By | October 31, 2016

With the mania of the presidential election in full tilt and the election just days away, it’s hard to have a rational public discussion about health care.  Supporters of the two presidential candidates have drawn a deep and divisive line (or rather a tectonic fissure) in the sand about health care reform.  This is due, in great part, to the bombastic, and ultimately… Read More »

The ACA vs. the doughnut hole: Medicare part D utilization and costs

By | September 8, 2016

President Obama’s Affordable Care Act (ACA) included provisions to gradually reduce the Medicare part D “doughnut hole” – a much-maligned gap in coverage that was an economizing feature of President Bush’s legislation. So, how have these changes affected drug use and spending by seniors? A new article in Medical Care provides insights. Under the standard part D benefit… Read More »

Gap in Payment for Medicare Cost Sharing Limits Access to Care for the Poor

Dual eligibility for Medicare and Medicaid is expected to improve access to care for low-income individuals who qualify for both programs, relative to eligibility for either program alone. Medicaid coverage of Medicare deductibles and co-payments can reduce the financial burdens that these cost sharing requirements may pose for low-income Medicare beneficiaries. These dual eligible beneficiaries… Read More »

Health care services use after Medicaid-to-dual transition for adults with mental illness

By | August 11, 2016

In 2013, there were 10.7 million people enrolled [PDF] in both Medicare and Medicaid. Dual eligibility depends on age, income, and disability. Dually enrolled beneficiaries are also responsible for a large share of program costs overall; 31% of Medicare fee-for-services spending for 18% of beneficiaries [PDF] who are dually enrolled. Given the additional health challenges [PDF] faced by dual eligibles, this… Read More »

All Falls Are Not Equal

By | June 9, 2016

All falls are not equal, nor is the financial impact of how Medicare defines fall-related injuries (FRI). In a new Medical Care article published ahead of print, I worked with colleagues at UCLA’s Fielding School of Public Health to explore whether Medicare expenditures associated with fall-related injuries (FRI) depend on how FRIs are identified in… Read More »

Measuring Cost-related Medication Burden

By | February 18, 2016

As readers of Medical Care are no doubt aware, prescription drug expenditures for Medicare beneficiaries are high – nearly $90 billion in 2012.  There is some evidence that Medicare Part D has reduced financial burdens, at least among some beneficiaries, but recent surveys suggest that around 4.4% of individuals ages 65 and older (including those not on… Read More »