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NEW Medicare Diabetes Prevention Program Now Available

A Medicare Diabetes Prevention Program (MDPP) was announced by the CDC to begin in 2018. The model will be added as a covered benefit for Medicare enrollees who meet the criteria. The program started April 1, 2018.

New Medicare Programs For Diabetes Can Result In You Saving Big!

Diabetes affects more than 25% of seniors 65 and older in America, and Medicare has spent billions on beneficiaries with diabetes. But type 2 diabetes can usually be delayed or prevented with healthy lifestyle changes.

The model offers a classroom-style support group that has gone through many successful pilots which resulted in better management for diabetes patients. The services include core sessions during the first 6 months, core maintenance sessions during the second month, and ongoing maintenance sessions during the second year. Check-ins are to make sure the participants are sticking to a healthy lifestyle. CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway believes that programs like these can prevent disease and help people live healthier lives.

The MDPP model aims to prevent type 2 diabetes from developing among Medicare beneficiaries. It will provide coaching services to prediabetic patients and help them lose weight. The goal is to reduce their weight by at least 5% from baseline and they must achieve this by the end of the first year to be eligible for ongoing maintenance in the second year.

People who went to more sessions had a much higher percentage of weight loss than those that skipped classes.

In the pilot tests conducted, patients who followed the program reduced their body weight by around 5% and lowered their spending by $2650 over the course of 15 months. The patients who attended more sessions had higher weight loss, which is the main goal of the program. “The final payment structure values beneficiary weight loss most significantly, as weight loss is a key indicator of success among individuals participating in a DPP due to the strong association between weight loss and reduction in the risk of type 2 diabetes,” CMS said.

“For the first time CMS, is going to be reimbursing for diabetes prevention based on this evidence-based program,” says Robert Gabbay, M.D., Ph.D., FACP, and Chief Medical Officer at Joslin Diabetes Center. “Currently the challenge is that when we identify people who are prediabetic, which is easy to do with a simple blood test, we don’t have a program to enroll them in that is reimbursed.”

Providers/physicians will receive Medicare reimbursement for providing the services to eligible patients. If their patients do not meet the required minimum weight loss, they will receive lower reimbursement rates and lose out on $160 per patient. But, if a patient successfully does the programs and meets the requirements, the provider could receive $610 per patient. If the patient comes to all the sessions but does not meet the 5% weight loss goal, the patient will help accrue $195 reimbursement for the provider.

Patients are eligible for the MDDP only once in their life because the CMS believes that the one-time benefit will be more likely to motivate them rather than allowing them to re-enroll any time. But, if a patient develops diabetes at any time during the program, then they can keep receiving services.

Diabetes is a national issue and is growing among children, adults, and senior citizens. This program that will be a preventative covered benefit will open up the idea of developing healthier lifestyles, and reduce the onset of diabetes. It is a hopeful step forward for Medicare beneficiaries.

If you need help searching for a Medicare Supplement plan, EZ.Insure can make sure you have an agent who knows the ins and outs of all the coverage options, local programs, and up to date rates in your area. Our agents are trained for your region and will work with your to find you the best plan for your needs at an affordable price. Don’t get stuck worrying about how to find coverage, let us make it easy for you. Simply enter your zip code in the bar above to get a quote, contact an agent by emailing us at [email protected], or call 855-220-1144.

Medicare Prices Steadily On The Rise

Details have emerged after a report was released on the investigation into Medicare drug prices. The report “Manufactured Crisis: How devastating drug price increases are harming America’s seniors,” and its findings were released by U.S. Sen. Claire McCaskill, Democrat-Missouri. This report talks about the hiked up drug prices for senior citizens and how it needs to be further investigated. Medications for seniors have gone up nearly 10 times more than the annual inflation rate.

The report stated that “Soaring pharmaceutical drug prices remain a critical concern for patients and policymakers alike. Over the last decade, these significant price increases have emerged as a dominant driver of U.S. health care costs — a trend experts anticipate will continue at a rapid pace.”

The cost of about 20 of the most prescribed drugs for Medicare have gone up significantly from 2012 to 2017 according to the report. The lowest increase being Zostavax going up 31%, to the largest increase being 477% for the drug Nitrostat. Twelve of the drugs investigated, increased over 50% during the five-year time span, while six of them increased over 100%. The rise has gone up so much that some Medicare enrollees are unable to pay for their meds.

Some Medicare Drug Prices Have More Than Doubled Each Year!

The Pharmaceutical Research and Manufacturers of America did not agree with the report and followed up with comments reported by CNN. “This is yet another misleading report that ignores the robust negotiation that occurs between Medicare Part D plans, middlemen, and biopharmaceutical companies,” Juliet Johnson, a spokeswoman for PhRMA, said in a written statement. “Negotiated rebates can reduce list prices by as much as 30 to 70 percent for medicines used to treat diabetes, high cholesterol, and chronic respiratory illnesses. Notably, half of the 20 brand medicines in this report are used to treat these chronic conditions.”

As stated, the medicines are used to treat chronic conditions, but the reality is that many seniors need these medications. A lot of Medicare enrollees have some sort of health issue, whether chronic or not that requires treatment and medication to stay healthy.

Juliet Johnson later stated “we agree more can be done to make Part D more affordable and predictable for seniors. One way to do that is to ensure seniors benefit from the significant negotiated savings when they pick up their medicine at the pharmacy.”

The prices of pharmaceutical drugs for seniors has been an ongoing issue, they are becoming more expensive every passing year. It can become too much for seniors to include in their budgets, which can be very harmful to their health. Medicare enrollees can purchase a Medicare Advantage plan or Medicare Part D plan to help pay for pharmaceutical drugs needed. But as drug prices continue to rise, the premium costs will go up as well to pay for the difference.

By law, Medicare is not allowed to negotiate drug prices, which is something Democrats have tried to change for a long time. Some sort of change or assurance must be given to seniors that these prices do not continue to climb and become unattainable. During Trump’s State of the Union address, President Trump states he will fight to make the drug prices go down. This will hopefully put a resolution of the soaring drug prices, and provide relief for seniors.

EZ.Insure will provide you with the best information on how to get the most out of your Medicare budget.. We provide you with your own personal advisor who is trained in your region to give you quotes and guidance on which plan will work best for you. To get a quote, email [email protected], enter your zip code in the bar above, or call 855-220-1144. It’s that simple and easy to start saving.

Uber Launching ‘Uber Health’

Uber has announced a new business line called Uber Health that will provide a ride-hailing platform for healthcare providers. Uber is offering to take patients to their medical appointments, as long as they are operating in the area. The health care providers that will use this business will be the ones billed for the services, not the patients.

Health care providers can set up car ride appointments within a few hours or up to thirty days in advance for patients. In order to ensure anyone can use this service, Uber has stated that the patient will not be required to have the Uber app or a smartphone. The company will use text messages to coordinate the rides, and they will have the ability to utilize both mobile and landline features to communicate with patients.

A centralized dashboard will let providers in the healthcare industry be able to assist their patients with transportation that is in compliance with HIPAA, Health Insurance Portability and Accountability. The health provider will put in the client’s name, number, pick up and drop off locations, and then choose one of Uber’s ride-hailing vehicle type. The client will receive a text message or voice call notifying them of the booking. The system has a management system that will keep track of all of the billing and reporting.

Uber began testing the platform last summer with over 100 healthcare providers signing up including clinics, hospitals, rehabs and physical therapy centers. The reason for starting the service is due to statistics claiming that 3.6 million Americans miss medical appointments because they lack reliable transportation.

“There are a lot of people out there who are not going to the doctor simply because they can’t physically make it there,” said Uber Health executive Jay Holley.

“If there are people who are missing their appointments because they’re using an unreliable bus service to get to and from their healthcare provider, this is a great solution for them,” Chris Weber, general manager of Uber Health, told in an interview. “The types of individuals this is valuable for really is limitless.”

“Uber’s endeavors into health care trace back to 2014, when Uber first offered on-demand flu shots in large markets across the U.S.,” he said, regarding the genesis of the focus on health within Uber. “Since then there have been similar efforts throughout the world, from diabetes and thyroid testing in India to subsidized rides for breast cancer screening in the U.S., to many more. That said, all of these efforts have been pop-ups.” This all led them to figure out a way to make a more permanent solution to reducing missed appointments.

In order to comply with HIPAA, Uber drivers will not be told or aware that they are driving someone that is using Uber Health. The drivers will have a limited amount of information such as the passengers’ name, and their pickup and drop off points.

Uber wanted to make it clear that they are not a replacement for an ambulance or for emergency situations. They will not be sent to transport people who need immediate attention. Uber hopes to help lessen the gap of Americans missing their doctor appointments, and focus on wheelchair accessibility for those who need it. Weber said, “It’s definitely something we’re focused on making a better, more reliable experience, but as of now this is really focused on reaching out to the existing driver network.” Uber is hoping to expand in more than 250 cities in the U.S. and make this new line of business successful.

Changes To Medicare Advantage in 2018

Medicare Advantage Plans have become very popular over the years, and like other insurance plans, changes occur every year. The most common changes are the list of drugs that are covered, how much your insurance company charges for them, premiums, and the percentage the plan pays towards your medical expenses. Changes can leave customers confused and with fewer options so it is important to look out for changes in the year ahead in order to get the proper care you need.

Changes in existing plan

Insurance companies will notify customers of changes in their existing Medicare Advantage plan occurring the following year. It is important to look over the changes of your current plan, and determine if these changes will cover your needs next year.

Loss of State Health Insurance Assistance Programs

State Health Insurance Assistance Programs, also known as SHIPS, aim to assist people with their Medicare options and compare Medicare Advantage plans. They provide counseling in every state, which is useful when trying to pick a Medicare plan for the year. These programs are funded by the federal government, but due to the Trump Administration’s budget cuts, it can be discontinued. The budget will eliminate funding of these state assistance programs by 94%, possibly eliminating them. However, EZ.Insure will continue to assist people with their Medicare and Medicare Advantage options even after these programs are gone. EZ.Insure always provides constant counseling, and help seeking the most ideal plan.

Network coverage

Insurance companies are constantly looking for doctors, hospitals, and other healthcare providers with cheaper rates to save money. The insurers negotiate with these providers to find the lowest cost each year, which is why plans change their network coverage every year. In the past couple of years, the network of providers has gotten smaller, with fewer specialists. It is important to make sure that your physician or specialists are included in your network year to year.

Loss of insurers

Reports from the Kaiser Family Foundation found that as of 2017, 147 counties across 14 states do not have Medicare Advantage plans. Some rural counties have been left with either only one or no insurers to choose from. If a Medicare Advantage plan is not an option, some people should consider a Medicare Supplement plan.

With all the changes occurring in the upcoming year, and loss of network coverage, it can be difficult to find a plan. At EZ Insure, we are dedicated to helping you compare and find a plan in your region. Contact us through email, [email protected], or enter your zip code in the link above to receive a quote. We make it that easy.

Tag: medicare insurance

NEW Medicare Diabetes Prevention Program Now Available

Medicare Prices Steadily On The Rise

Uber Launching ‘Uber Health’

Changes To Medicare Advantage in 2018

Changes in existing plan

Loss of State Health Insurance Assistance Programs

Network coverage

Loss of insurers

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