Understandably, Americans fear the federal government these days at least as much as they value federal action. Federal action promoting the public good gets far less attention and credit than it sometimes deserves. Most recently, HealthCareDive reports that the Centers for Medicare and Medicaid Services (CMS) improved Medicare coverage, putting Medicare ahead of the private health insurance industry in ensuring that Americans get the health care they need.
The federal government can be a force of good in ways that state and local governments cannot. With health insurance, for example, CMS tends to be a leader, supporting innovations in traditional Medicare–public health insurance–which private insurers end up following. Most recently, CMS expanded Medicare coverage of telehealth services and increased payments to primary care providers across the nation.
Telehealth services are growing dramatically for people with Medicare. Before the pandemic, in a given week, 15,000 people with traditional Medicare used telehealth services. In the seven months between mid-March and mid-October, 24.5 million people in traditional Medicare used telehealth services.
We have far less information about the services people in Medicare Advantage plans–the private insurance plans that contract with the federal government to provide Medicare benefits–are using. Good data is not available. Lack of data is a serious limitation of private health insurance that should be of grave concern to people with Medicare, public health experts, researchers, lawmakers and the public at large.
The private Medicare Advantage plans are largely unaccountable for the hundreds of billions of dollars they receive every year to deliver Medicare-covered services, even though they have been found to be overcharging the federal government tens of billions of dollars every year and engaging in widespread inappropriate delays and denials of care. The private health insurers covering working people are no better and likely far worse, as these insurers tend to be even less accountable than Medicare Advantage plans.
Under the new CMS rules, people in traditional Medicare can now receive group psychotherapy through telehealth as well as home visits and care planning services. People in Medicare Advantage plans should also be covered for these services, as Medicare Advantage plans are supposed to cover all Medicare-covered services.
The Medicare Payment Advisory Commission, MedPac weighed in on Medicare’s new payment rules, saying that they could increase access to care for people with Medicare. Medicare, like private health insurers, has traditionally underpaid primary care providers. Traditional Medicare has now increased payment rates to primary care doctors for evaluation and management services.
Here’s more from Just Care:
- Medicare Advantage: Will you get care from the doctors you want to see at a price you can afford?
- The Medicare Advantage scam and beyond
- The wrong choice of Medicare Advantage plan could kill you
- Justice Department sues Anthem for Medicare Advantage fraud
- People with serious health needs more likely to disenroll from Medicare Advantage plans
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