News That Helps Idaho Residents Stay Informed


The purpose of this article is to provide Idaho residents with one consolidated place to reference newsworthy information about Medicare and how it may help them make better decisions. Some of this material will not be found on the Medicare or CMS web site and may be rotated off this site as its ‘information value’ decreases with time.


Medicare News: “U.S. proposes 0.9 percent cut in 2016 Medicare Advantage payments”

Synopsys: “The U.S. government on Friday proposed a 0.9 percent cut in payments to health insurers for 2016 Medicare Advantage plans, which provide health benefits to more than 16 million elderly or disabled people.

The cut is part of a notice issued by a division of the U.S. Department of Health and Human Services that sets premium rate benchmarks for Medicare Advantage plans. It reflects a 1.7 percent increase in healthcare spending as well as payment rates for factors such as health plan quality ratings, health reform costs, and sicker-than-average customers.”
Access this article here

Date published:  February 20, 2015


Medicare News: “Majority of Medicare Advantage Enrollees Switching From Traditional Medicare”

 Synopsys: ‘A majority of seniors who enrolled in Medicare Advantage between 2006 and 2011 actually switched from traditional Medicare, a change most common among 65- to 69-year olds’

‘Since Medicare is paying so much of the cost of Medicare Advantage, in general terms it’s less expensive for MA members to have their plans than to cover their gaps with a Medicare supplement.” Advantage plans also have an out-of-pocket maximum of $6,700 per year’

Those perks can be deceiving, however, and Advantage enrollees often find themselves with unexpectedly high out-of-pocket costs once they face serious medical conditions. “They usually have no idea they’re in closed networks [HMOs] of doctors and hospitals,” said Jim Merklinghaus of JBM Financial. “Advantage plans are attractive from the onset, but once customers need coverage, they’re often disappointed.

According to a Kaiser Family Foundation review of access to care under private and traditional Medicare plans, HMOs usually perform better at providing preventive services, while traditional Medicare does a better job for beneficiaries who are already sick. Because of this discrepancy, Advantage customers who need out-of-network care may end up with far higher overall healthcare costs than if they had enrolled in the more inclusive traditional Medicare in the first place.

Access this article here 

Date published:  February 2, 2015


Medicare News: “2016 Budget Plan Sees Savings in Changes to Medicare”

 Synopsys: ‘cut $43 billion over 10 years from the projected growth of federal payments to Medicare managed-care plans, known as Medicare Advantage plans; collect $66 billion over 10 years by charging higher premiums to higher-income Medicare beneficiaries; ban deals between brand-name and prescription drug manufacturers that he says delay the marketing of lower-cost generic medicines; proposed expansion of Medicare benefits that would eliminate the existing 190-day lifetime limit on coverage of inpatient care in psychiatric hospitals; etc.

WASHINGTON — In his new budgetPresident Obama proposed on Monday to squeeze $399 billion over the next 10 years out of MedicareMedicaid and other programs run by the Department of Health and Human Services.

Under the proposals, many Medicare beneficiaries would have to pay more for their care and coverage.

Access this article here 

Date published:  February 2, 2015


Medicare News: CMS releases final payment rules for the Medicare program


Synopsys: Aligning the way providers are paid to reward value rather than volume.

  • Paying providers for quality, not quantity of care. In 2015 Medicare is continuing to phase in the Value-based Payment Modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish to beneficiaries. Those adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.
  • Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes provisions that promote greater packaging of payments for items and services rather than making separate payments for each individual service. For example, a new comprehensive Ambulatory Payment Classifications payment policy is being implemented in CY 2015 to make a single payment for all related hospital items and services provided to a patient receiving certain device-dependent procedures, such as insertion of a pacemaker, rather than separate payments for each supportive service, such as routine tests and diagnostic procedures.”


Access this article here 

Date published:  Friday, October 31, 2014


Medicare News:Three Idaho hospitals to be docked Medicare pay for low performance in patient safety


Synopsys: “The federal government will dock Boise-based Saint Alphonsus Regional Medical Center’s Medicare payments for a year because the hospital missed targets for patient safety and satisfaction, according to data released by Medicare.”
Access this article here 

Date published:  December 25, 2014


Medicare News: “Medicare To Offer Help To Some Seniors When Advantage Plans Drop Doctors

Synopsys: “Last year, thousands of seniors in at least 10 states were left stranded or assigned new doctors when insurers discontinued contracts with the physicians.  Starting next year, the government will offer some seniors enrolled in private Medicare Advantage insurance an opportunity to leave those plans if they lose their doctors or other health care providers.

Access this article here 

Date published:  December 22, 2014

Medicare News: “Idaho gets U.S. grant to improve health care

Synopsys: ” A group of stakeholders that includes insurance companies, Idaho Medicaid, local doctors and others used the grant to craft a master plan to change Idaho’s health care industry. That plan just won Idaho a $39.7 million grant from the Center for Medicare and Medicaid Innovation. The money will be doled out mostly in contracts from the Idaho Department of Health and Welfare for technology, administration, organization, training and other expenses.

Over the next four years, it will affect most people in Idaho who get medical care.”
Access this article here

Date published:  December 21, 2014


Medicare News: “U.S. Finds Many Failures in Medicare Health Plans

Synopsys: ” WASHINGTON — Federal officials say they have repeatedly criticized, and in many cases penalized, Medicare health plans for serious deficiencies, including the improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs.

The findings, cataloged in dozens of federal audit reports, come as millions of older Americans prepare to sign up for private health plans and prescription drug plans in Medicare’s annual open enrollment period, which will begin on Wednesday and continue through Dec. 7.

About 16 million people, accounting for 30 percent of the 54 million beneficiaries, are in private Medicare Advantage plans, which provide a full range of health care services under contract with the government. An additional 23 million people are in prescription drug plans, which cover only medications.”


Access this article here

Date published:  October 13, 2014


Medicare News: “A Drug Mule for the Medicare Set”

Synopsys: ” I quickly learned that the “doughnut hole” has nothing to do with baked goods and is, instead, the term used to describe the gap my mother had now reached in her Medicare Part D prescription drug program. She had hit her initial coverage limit of close to $3,000 a year (calculated by adding together the full fee of all her drugs), and now would have to pay a higher out-of-pocket cost for her prescription drugs until she reached the catastrophic coverage threshold, thousands of dollars later.

Given that she also takes other medications, her drug costs were suddenly going to go through the roof — and as I share that roof with my parents, husband, brother and children, it was also going to skyrocket our mutually managed budget. Her heart medication alone would now cost more than $800 for a three-month supply. Now it was my heart that was starting to palpitate. But it turned out that my parents had a plan.

Call it “The Dallas Buyers Club of Seniors,” but a number of their octogenarian friends are now ordering their prescription drugs through pharmacies in Canada. Living in Michigan, as we do, the border is an easy maple-syrup-outing away.”

 Access this article here

Date published:  October 13, 2014


Medicare News: “You better shop around: Medicare’s looming open enrollment

Synopsys: ” Most people age 65 or over this open-enrollment period—which runs from Oct. 15 through Dec. 7—are expected to stick with their existing plan choices, just as they’ve done in past years.

That phenomenon, experts agree, can leave seniors on the hook for otherwise avoidable health-related expenses when they learn their preferred doctors, hospitals and prescription drugs are not covered in the same ways, if at all, by their existing Medicare plan.”

Access this article here

Date published:  October 7, 2014


Medicare News: “Officials Question the Rising Costs of Generic Drugs

Synopsys: “The prices of some generic drugs have soared more than 1,000 percent in the last year, and federal officials are demanding that generic drug makers explain the reasons for the increases or potentially face new regulation.

The increased use of generic drugs has been one of the rare success stories in national efforts to curb the nation’s $2.8 trillion medical bill, since generics have historically been far cheaper than name-brand versions. More than eight in 10 prescriptions are filled with generic drugs, according to the Food and Drug Administration. In the 10-year period from the beginning of 2003 through 2012, generic drug use has generated more than $1.2 trillion in savings, according to the Generic Pharmaceutical Association.

Drug prices can rise for several reasons related to normal shifts in supply. Companies can leave the market, resulting in decreased supply and less competition. A factory producing the drug may be temporarily closed for violations. But there has been increasing concern that, in some cases, prices rise because of questionable business practices or market manipulation. In the last several years, the Federal Trade Commission and state attorneys general have taken aim at a practice called “pay for delay,” in which brand manufacturers pay generic drug makers to hold off entering the market.”


Access this article here

Date published:  October 7, 2014


Medicare News: “How are Seniors Choosing and Changing Health Insurance Plans?”

  • Synopsys: “Seniors say they found it frustrating and difficult to compare plans due to the volume of information they receive in the mail and through media (television and radio) and their inability to organize the information to determine which plan is best for them.  Most seniors did not use the “Medicare Compare” tool available on the website, and many of those who did said they found it confusing, lacking information, and poorly constructed for comparisons on their desired factors.   For this reason, many rely on insurance agents as trusted advisors or receive suggestions from friends, family, doctors’ offices and/or pharmacists to help them narrow down their options.”


Access this article here

Date published:  May 13, 2014


Medicare News: “St. Luke’s Named Top 15 Health Systems”


Synopsis: “Truven Health Analytics Has names St. Luke’s Health System as one of the nation’s top 15 Health Systems.”

This is the first year St. Luke’s has achieved this recognition, which is based on an evaluation of key performance and safety measures. St. Luke’s is the only Idaho health system included on the Top 15 list – a list that includes other notable health systems such as the Mayo Clinic and Advocate Health.”


Access this article here

 Date published: Apr 25, 2014 at 9:30 AM MDT


Medicare News: “Medicare Agency Says Payments to Insurers Will Rise in 2015”


Synopsis: “analysts said the final 2015 rates still appeared to reflect a reduction in payments compared with 2014, though not as steep as the February version. A.J. Rice, an analyst with UBS, estimated the final impact as roughly a 3% cut. “

Access this Wall Street Journal article by cutting and pasting the words below into the Google search engine; they are: “Medicare Agency Says Payments to Insurers Will Rise in 2015″


Date published: April 7, 2014 11:37 p.m. ET


Medicare News: “Obama signs bill temporarily fixing Medicare fees”


Synopsis: “WASHINGTON (AP) — President Barack Obama Tuesday signed into law legislation to give doctors temporary relief from a flawed Medicare payment formula that threatened them with a 24 percent cut in their fees.”

Access this article here

Date published: Apr 1, 2014 


Medicare News: “A Quiet ‘Sea Change’ in Medicare”


Synopsis: “In January, Medicare officials updated the agency’s policy manual — the rule book for everything Medicare does — to erase any notion that improvement is necessary to receive coverage for skilled care. That means Medicare now will pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration..”


Access this article here 

Date published: 3/25/2014


Medicare News:  Medicare Changes Prompt Enrollees to Reconsider Plans

Synopsis: “ One reason Medicare Advantage plans have attracted a growing number of Americans — 29 percent of the 52 million Medicare recipients have chosen them, according to Avalere Health, a research firm — is that they have been, in effect, subsidized by the federal government. Now the government is reducing, over time, what it pays the private plans, bringing payments in line with those for traditional Medicare. “It only makes sense for the government to pay the same amount to private insurers as they do to Medicare providers,” said Judith A. Stein, executive director of the Center for Medicare Advocacy. “Insurers should be able to operate profitably with those payments without cutting back dramatically on service.”.”

“United Healthcare cut 10 to 15 percent of providers from its Medicare Advantage networks last year, including the Moffitt Cancer Center in Tampa, Fla., and the Yale Medical Group in New Haven, which has more than 1,000 physicians. United Healthcare declined to comment for this article.”

Access this article here

Date Published: March 12, 2014



Medicare News:  Summary of Medicare Provisions in the President’s Budget for Fiscal Year 2015


Synopsis: “ The President’s FY2015 budget would reduce Medicare spending by more than $400 billion between 2015 and 2024, accounting for about 25 percent of all reductions in federal spending included in the budget.  Most of the Medicare provisions in the FY2015 budget are similar to provisions that were included in the Administration’s FY2014 budget proposal.  The proposed Medicare spending reductions are projected to extend the solvency of the Medicare Hospital Insurance Trust Fund by approximately five years.”


Access this article here

Date Published: March 11, 2014


Medicare News:  Proposed Medicare Part D Drug Changes Are Scrapped

Synopsis: “ The Obama administration said Monday that it would scrap much of a proposed plan to limit the types of antidepressants and other drugs that seniors can get through Medicare after a backlash from lawmakers and the health industry.”

Access this article:

1). If you have a subscription to the Wall Street Journal, access this article here.

2) If you do not have a subscription to the Wall Street Journal, cut/paste the information following ‘The search terms are:” into ‘Google search’ and you will be given the opportunity to read the complete article. 

The search terms are: Proposed Medicare Part D Drug Changes Are Scrapped

Date Published: March 10, 2014


Medicare News:  West Valley Medical Center named a top 100 hospital

Synopsis:  “CALDWELL — West Valley Medical Center has been named one of the nation’s top 100 hospitals by Truven Health Analytics, the hospital announced Tuesday.

Read this article here 

Date Published: March 5, 2014




Medicare News: Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments

Synopsis:  “For years, Medicare Advantage plans were paid on average more per beneficiary than what Medicare paid for beneficiaries enrolled in traditional fee-for-service. The health law aims to equalize that federal spending over time, so the government pays the same amount whether a beneficiary enrolls in Medicare Advantage or traditional Medicare. Cuts to Medicare Advantage plans are part of the $716 billion in Medicare spending reductions the health law calls for over the next decade.”

Read this article here 

Date Published: February 21, 2014


Medicare News: Seniors Could Face $420-$900 in Higher Costs, Reduced Benefits Next Year Due to New Medicare Advantage Rate Cuts

Synopsis: “Seniors and people with disabilities enrolled in Medicare Advantage plans could face premium increases and benefit reductions of $35-$75 per month, or $420-$900 next year, if Medicare Advantage (MA) payments are once again reduced by six percent in 2015, according to a new analysis by Oliver Wyman prepared for America’s Health Insurance Plans.” -

Read the article: here 

Date Published: Feb 6,2014


Medicare News:  Bills would make Idaho hospitals post data on prices, outcomes

Synopsis: “ Rep. Brandon Hixon, R-Caldwell, introduced a bill on Tuesday to build a website and a mobile application where patients could see prices for the 50 most common procedures at Idaho hospitals and surgical centers. The bill also would require health care facilities to give out more pricing information, such as estimates of charges and itemized bills when patients go home.”

“Some Idaho hospital data is already available online. The U.S. Department of Health and Human Services recently made available some information on pricing and performance. Websites such as offer a window into emergency room wait times, safety, patient satisfaction and other data for hospitals in Idaho. The Centers for Medicare and Medicaid Services last year revealed for the first time what hospitals nationwide charged for 100 common procedures, the number of those procedures the hospitals performed, and the actual dollar amount Medicare paid to the hospitals for each procedure.

Access this article: Read more here

Date Published: February 13, 2014


Medicare News:  St. Luke’s in Boise cutting costs due to $65 million revenue decline

Synopsis:“We want to make it clear that this decline doesn’t surprise us, and it shows that we are starting to see some success in our efforts to transition care [from] the fee-for-service to pay-for-value model. … Going forward we expect that this will be the new normal as we continue to make that transition. I would add that the employees and departments at St. Luke’s have been really stepping up and identifying areas where we can reduce waste and cut costs.”

Access this article: Read more here.

Date Published: February 12, 2014


Medicare News: Humana Swings to Loss on Increased Costs

Synopsis: “ Humana and its peers face shrinking government funding for Medicare Advantage plans, which are the private industry’s version of the health plan for the elderly and disabled. Humana is more tethered to these plans than any other big insurers, making its ability to digest lower incoming payments while guarding profit margins a key issue.

Access this article:

1). If you have a subscription to the Wall Street Journal, access this article here.

2) If you do not have a subscription to the Wall Street Journal, cut/paste the information following ‘The search terms are:” into ‘Google search’ and you will be given the opportunity to read the complete article. 

The search terms are: Humana Swings to Loss on Increased Costs

Date Published: February 5, 2014


Medicare News: Understanding Idaho’s Doctor Shortage

Synopsis: ” Since at least 2007, Idaho has ranked near the bottom when it comes to the number of doctors working in the state.

The latest available data from the Association of American Medical Colleges ranks Idaho 49th among states.

The Gem State had 184 doctors for every 100,000 people in 2010.”

Access this article here



Medicare News:  New Medicare Data Show Hospitals With High Rates of Readmission – Idaho hospitals among those with the lowest readmission rates

Synopsis: “Medicare’s new comprehensive measure of hospital readmissions shows that at least 20 percent of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island have higher rates of patients returning than the national average.

Colorado, Hawaii, Idaho, North Carolina, Oregon, South Carolina, Utah and Washington led the states with the highest proportion of hospitals with low readmission rates. In those states, between 13 and 16 percent of hospitals came in below the national average, the data show.”

Access this article here.

Date Published: January 6, 3:03 AM



Medicare News: Dialysis centers face payment cuts

Synopsis: “A looming 9.4 percent reduction in Medicare reimbursement rates that providers and advocates worry will force some centers to close their doors, lay off workers or sacrifice quality of care. That would reduce the average per-patient payment from about $230 to $200.

The lower rates will likely take effect in 2016, unless the federal Centers for Medicare and Medicaid Services decides payments need to be increased. Providers say they’re not optimistic.”

Access this article here.

Date Published:  December 28, 2013 



Medicare News: Medicare Identifies 97 Best And 95 Worst Hospitals For Hip And Knee Replacements

Synopsis:  “Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals where elderly patients were more likely to suffer significant setbacks. The government also named 97 hospitals where patients tended to have the smoothest recoveries.”

Access this article here.

 Date Published: December 17, 2013


Medicare News: UnitedHealth Culls Doctors From Medicare Advantage Plans

Synopsis:UnitedHealth Group Inc., the nation’s largest provider of privately managed Medicare Advantage plans, has dropped thousands of doctors from its networks in recent weeks—spurring protest from lawmakers and physician groups and leaving many elderly patients unsure about whether they need to switch plans to keep seeing their doctors.”

“The federal government pays private insurers a per-capita fee to manage the benefits. The rate is currently about 12% more than the average Medicare patient spends annually. The Obama administration plans to cut those extra payments to insurers by about $150 billion over the next 10 years to help pay for the health law. Some experts expect enrollment in Medicare Advantage plans to decline sharply if that occurs.”

Access this article:

1). If you have a subscription to the Wall Street Journal, access this article here.

2) If you do not have a subscription to the Wall Street Journal, cut/paste the following into ‘Google search’ and you will be given the opportunity to read the complete article.  The search terms are: UnitedHealth Culls Doctors From Medicare Advantage Plans

Date Published: Nov. 16, 2013


Medicare News: St. Luke’s splits from Humana plan over money

Synopsis: “Treasure Valley residents who have private plans from Humana to complement their bare-bones Medicare coverage might have to change where they get medical care.

St. Luke’s Health System will no longer be part of Humana’s Medicare Advantage network starting Jan. 1. That means St. Luke’s patients with Medicare Advantage plans from the Kentucky-based insurer will need to find new providers or pay more out-of-pocket costs to stick with St. Luke’s.

Humana canceled the contract in August because of a disagreement over payments, said St. Luke’s spokesman Ken Dey. Humana wanted to change its contract to pay St. Luke’s less than Medicare does, Dey said.”

Access this article here.

Date published: November 13, 2013


Medicare news: Long-term care costs 101 – Calculating expenses and determining how to pay for it

Synopsis: “There are important realities every American must know about long-term care. Long-term care is more expensive than most people think. And, most importantly, the cost of care is usually paid for out of savings and income.

About 70 percent of people turning 65 can expect to need some kind of long-term care as they age. A number of public programs, including Medicare and Medicaid, may help pay for some long-term care services under certain circumstances. However, each program has specific rules about what services are covered, how long you can receive benefits, whether or not you qualify for benefits, and how much you have to pay in out-of-pocket costs.”

Access this article here.

 Date published: December 1, 2013



Medicare News: White House Touts Idaho Statistics In Defending Obamacare

Synopsis:In the first eleven months of 2013, an additional 111,400 people with Medicare have received at least one preventative service at no out of pocket cost.

- In the first 10 months of 2013, 12,100 seniors and people with disabilities have saved on average $701 on prescription medications.”

Access this article here.

Date Published:  Dec 19, 2013 at 9:46 AM



Medicare News: Hospice: answers to important questions

 Synopsis:In the past, a hospice was defined as a shelter or refuge – a peaceful place to rest while on a long journey. Today, the word is too often viewed with fear and sorrow: Families contact hospice as a last resort when their loved ones are dying. But returning to the original definition might make more sense, since the services hospice offers are much closer to supporting an individual on their journey instead of helping them end it.

Hospice is a scary word, associated with death and dying,” said Tiffany Jones, marketing director/patient care coordinator at Crest Home Health & Hospice. “It’s more about quality of life.”

Access this article here:

Date published: November 30, 2013 12:00 am



Medicare News: How Fraud Flourishes Unchecked In Medicare’s Drug Plan

Synopsis: “Today, credit card companies routinely flag or block suspicious charges as they happen. Yet under Medicare, a convoluted and poorly managed system for catching fraud allows scams to flourish, an investigation by ProPublica found.

Frustrated investigators for law enforcement, insurers and pharmacy chains say they don’t see evidence that Medicare officials are doing much to stop it.”

Access this article here

Date published: December 22, 2013


 Update to the Above Article


Medicare News: Medicare Seeks To Tighten Drug Program Rules To Fight Fraud

Synopsis:  Draft regulations issued Monday would overhaul the prescription drug program and could save up to $1.3 billion over five years.

Access this article here

Date Published: January 7, 2014


Medicare News: Medicare Reveals Seniors’ Mail Order Pharmacy Nightmares

Synopsis:Nearly 1,200 seniors have complained to Medicare this year about a litany of problems with mail order pharmacies, including shipping unneeded medication and going without medication due to delayed shipments, according to documentation recently released by the U.S. Centers for Medicare & Medicaid Services (CMS).

Starting Jan. 1, 2014, CMS will require Medicare Part D prescription drug plans (PDPs) to ensure that their contracted pharmacies affirmatively obtain consent from a beneficiary (or their caregiver) prior to shipping or delivering a new or refill prescription. The change comes in response to CMS receiving complaints from patients and cases documented by the National Community Pharmacists Association (NCPA) of individuals turning vast quantities of unused or expired medication (often provided through mail order auto-refills) into community pharmacies for disposal. Most mail order pharmacies are owned by pharmacy benefit managers (PBMs).”

Access this article here.

Date published: Dec. 17, 2013 /PRNewswire-USNewswire



Medicare News: States to get Medicaid cases from federal website

Synopsis: Coordination between state Medicaid offices and Centers for Medicare and Medicaid Services should be getting better; this means life for ‘dual eligibles’ should get better as the two government agencies are actively coordinating information.

Access this article here.

Date Published: December 17, 2013


Medicare News: Montana Health Co-op Plans Expansion to Idaho

Synopsis: “Montana Health Co-op officials say they’re preparing to expand into Idaho.   The centers for Medicare and Medicaid services have announced MHC has been approved to receive more than 22 million dollars in funding to bring a non-profit health insurance option to the people of Idaho.”

Access this article here

Date Published: Tuesday Dec. 3rd, 2013 – 1:50pm