WHITE PAPER
As healthcare costs and insurance premiums continue to rise at a pace far surpassing inflation, payers have responded to the mounting economic pressures by employing complex billing and coding rules to eliminate inappropriate payments. Lacking adequate error detection and research tools, the typical healthcare business suffers from a backlog of denied claims and diminished revenues. Read this paper to learn how to rescue your flagging Medicare reimbursements.

HHS tallies savings for Medicare beneficiaries under ACA


The U.S. Department of Health & Human Services (HHS) estimates that the average person with traditional Medicare will save $5,000 between 2010 and 2022 because of provisions of the Affordable Care Act (ACA). HHS also pointed out that Medicare beneficiaries who have high prescription drug costs will save more than $18,000 over the same period.

[See also: Medicare stable until 2024, trustees report ]

HHS Secretary Kathleen Sebelius said that more than 5.5 million seniors and people with disabilities saved nearly $4.5 billion on prescription drugs since ACA was enacted.  Seniors in the Medicare prescription drug coverage gap known as the "donut hole" have saved an average of $641 in the first eight months of 2012 alone, HHS reported. This includes $195 million in savings on prescriptions for diabetes, over $140 million on drugs to lower cholesterol and blood pressure, and $75 million on cancer drugs so far this year. 

Also, in the first eight months of 2012, more than 19 million people with original Medicare received at least one preventive service at no cost to them, according to HHS.

“I am pleased that the healthcare law is helping so many seniors save money on their prescription drug costs,” Sebelius said in a prepared statement.  “A $5,000 savings will go a long way for many beneficiaries on fixed incomes and tight budgets.”

[See also: Medicare preventive services provided to 12 million patients through first four months of 2012]

The healthcare law includes benefits to make Medicare prescription drug coverage more affordable. In 2010, anyone with Medicare who hit the prescription drug donut hole received a $250 rebate. In 2011, people with Medicare who hit the donut hole began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs. Those discounts and Medicare coverage gradually increase until 2020, when the donut hole will be closed.

HHS noted that, prior to 2011, people with Medicare had to pay for many preventive health services. For example, prior to ACA enactment, a person with Medicare may have paid as much as $160 for a colorectal cancer screening.  The ACA offers many free preventive services to beneficiaries (with no deductible or co-pay) so the cost is no longer a barrier for seniors who want to stay healthy and treat problems early, the agency said.

In 2012 alone, 1.9 million who have taken advantage of the Annual Wellness Visit provided by the ACA – almost 600,000 more than had used this service by this point in the year in 2011.  In 2011, an estimated 32.5 million people with traditional Medicare or Medicare Advantage received one or more preventive benefits free of charge, HHS said.

Click here for state-by-state information on savings in the donut hole.

Click here for state-by-state information on utilization of free preventive services.

  [See also: HHS looks to states to innovate in improving care and lowering costs]

Add new comment