Medicare provides health coverage to people either over the age of 65 or physically disabled, irrespective of age. Coverage is divided into three major components:
Part A ( inpatient hospital stays), Part B (outpatient expenditures) and Part D (prescription drug coverage). According to data collected by AARP, 16% of the nation's population or over 50 million Americans rely on Medicare for health coverage and it serves as a safety net for some of our most vulnerable citizens. Half of all Medicare beneficiaries live well below the poverty level (with 9 million of them dually enrolled in Medicaid) and 40% of people enrolled in Medicare have 3 or more chronic conditions. Individuals enrolled in Medicare with greater than $85,000 in income, pay more for Medicare coverage.
The journey toward making Medicare more soluble has already begun with the implementation of the Affordable Care Act, in part through cost savings from going after Medicare fraud and abuse. On 5/13/14 USDHHS announced another round of Medicare Fraud Takedown. "Medicare is a sacred compact with our nation's seniors, and to protect it, we must remain aggressive in combating fraud," said Attorney General Holder. "This nationwide Medicare Strike Force takedown represents another important step forward in our ongoing fight to safeguard taxpayer resources and to ensure the integrity of essential health care programs. Department of Justice will not tolerate these activities. And we will continue working alongside the Department of Health and Human Services -- as well as federal, state, and local partners -- to use every appropriate tool and available resource to find, stop, and punish those who seek to take advantage of their fellow citizens."
"The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day," said Secretary Sebelius. "By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars. Today we're sending a strong, clear message to anyone seeking to defraud Medicare: You will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee."
The rising costs of Medicare Advantage which offers the option of receiving Medicare benefits through private insurers are also being reined in through the provisions of the Affordable Care Act by reducing federal payments to Medicare Advantage plans over time, bringing them closer to the average costs of care under the traditional Medicare program. The law also provided for new bonus payments to plans based on quality ratings, beginning in 2012, and in 2014 required plans to maintain a medical loss ratio of at least 85%, meaning restricting the share of premiums that Medicare Advantage plans can use for administrative overhead and profits.
The Affordable Care Act rolled out several Medicare initiatives for improving care coordination and transitional care (between health care settings) for beneficiaries with chronic conditions, including the following:
Partnership for Patients
Community-based Care Transitions Program
Post-discharge Transitional Care Management
Medicare Hospital Readmission Reduction Program
Home Health Services for Caregivers of Alzheimer's Patients
Independence at Home Demonstration
Patient-centered Medical Homes (Advanced Primary Care Practices)
Testing New Models for Chronic Care Coordination
Early indicators demonstrate the efficacy of these innovative initiatives in caring for a growing number of frail elders in America as well as supporting family caregivers. Congress should continue to track indicators of quality health care, quality of life and cost-effectiveness and move forward those initiatives that make a meaningful difference and manifest a sustained return on investment.