Drug plan reshuffling for dual eligibles could occur next year

Share this article:

The government is concerned about a disruption in Medicare drug-plan coverage for dual eligibles next year if certain plans lose their eligibility to serve this population.

This week, an official with the Centers for Medicare & Medicaid Services said that plans that offered bids low enough to be eligible to enroll dual eligibles this year may not make bids low enough next year, according to the Bureau of National Affairs. Approximately 70% of all nursing home residents are considered dual eligibles, or those eligible for Medicare and Medicaid coverage.

Starting this year, a competitive pricing process determines payment rates to health plans. Plans submitted bids to CMS indicating the payment per enrollee they were willing to accept to provide benefits. Only those plans with bids that fall below the applicable regional benchmark -- and can offer low and small copayments -– are auto-assigned dual eligibles. Plans bid anew every June. Higher bids and industry consolidation may eliminate certain plans from serving dual eligibles next year.
Share this article:

More in News

Nursing home did not warn worker who was taken hostage in active ...

A nurse at a Life Care Centers of America facility in Colorado was not notified that she would be threatened and taken hostage by a gunman as part of an active shooter drill, according to a lawsuit filed Tuesday.

Revisions to False Claims Act urged by former deputy AG

A panel of witnesses debated the merits of the False Claims Act before a Judiciary subcommittee meeting Wednesday, with one former attorney general arguing current policy provokes unfair litigation and "coercive" settlements.

Medicare SNF rate finalized, reimbursements to increase by $750 million next year

Medicare SNF rate finalized, reimbursements to increase by ...

Medicare skilled nursing facility reimbursements will increase by $750 million next year under a final payment rule announced Thursday by the Centers for Medicare & Medicaid Services.