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 antipsychotic use has dipped nearly 19% under national effort, latest figures show

Nursing home antipsychotic use has dipped nearly 19% ...

The percent of long-stay nursing home residents receiving antipsychotic medication has decreased 18.8% under a nationwide initiative that started in 2012.

Jimmo succeeds in getting Medicare coverage, two years after landmark case ended

Glenda Jimmo has reached a settlement with the federal government and will finally receive Medicare coverage for claims that were denied in 2007, which led her to file a class-action lawsuit over the so-called "improvement standard."

Breier named new CEO at Kindred

Breier named new CEO at Kindred

Kindred Healthcare announced Thursday that it has chosen a new top executive to lead its push toward creating a mammoth national brand. Benjamin A. Breier, the company's current president and ...