As the insurance industry continues to keep up with the concerns of an aging population, news about long-term care and Medicare are the health-related issues that most interested InsuranceNewsNet’s readers in 2022.

A look at INN’s most-read health articles in the past year showed long-term care and Medicare featured in seven of the top 10.

But the most widely read health article of 2022 focused on a groundbreaking piece of federal legislation that has implications for those on Medicare.

Inflation Reduction Act contains ‘unprecedented’ health care provisions

In August, Congress passed the Inflation Reduction Act, which made major changes to Medicare as well as extended the enhanced tax credits that enable Americans to buy health insurance through the Affordable Care Act exchanges. Those enhanced tax credits were due to expire at the end of 2022, leaving an estimated 3 million people without coverage.

The bill also gave Medicare the ability to negotiate prescription drug prices, established a $2,000 cap on Part D out-of-pocket spending in 2025, and limits monthly cost sharing for insulin products to $35 for people with Medicare.

Long-term care crisis ‘sneaking up on most Americans’

A public health crisis is "sneaking up on most Americans" and that crisis is long-term care, according to Carroll Golden, executive director of the National Association of Insurance and Financial Advisors Limited and Extended Care Planning Center.

Golden presented some statistics that show a long-term care crisis is looming. For example, 70% of adults over age 65 will develop severe long-term needs before they die but only 48% will receive paid care.

“Almost all of your clients either will need care or will become a caregiver,” she added. “This is an opportunity for you to discuss long-term care with your clients.”

Medicare Advantage set to grab half the market, even as scrutiny tightens

Not only are Medicare Advantage plans growing in popularity in 2022, two companies will be responsible for nearly half of those enrollments: UnitedHealth Group and Humana.

MA plans and providers have been accused of fraud for overbilling the system, usually through upcoding, or the practice of finding a more lucrative designation for a patient’s conditions. That is because the system pays per patient, rather than for services – and the sicker the enrollee, the higher the reimbursement.

While MA plans are becoming more popular, some House Democrats want to distinguish Medicare from Medicare Advantage – specifically, they want MA to drop Medicare from the name and be called Alternative Private Health Plans. The Save Medicare Act was introduced in October by Reps. Mark Pocan, D-Wisc., and Ro Khanna, D-Calif., who say Medicare should be expanded to include the extra benefits, rather than paying private companies to handle them.

Alternative funding strategies for long-term care

Long-term care is a reality that everyone will eventually confront—either for themselves, a loved one, or both. But it is an expensive proposition that too few people are prepared for— or understand.

Unfortunately, most people don’t think about how they will pay for care until they are confronted by a serious health situation for themselves or a loved one. Long-term care is a topic people avoid until they are thrown into a crisis situation for which most are completely unprepared. The worst time to start planning is in the midst of a crisis because the options to pay for care can be complicated and take time to access.

The key to successfully navigating any long-term care situation is to understand the range of available financial options and understand the differences between what will be covered by Medicare, Medicaid, or Private Pay.  Planning as far in advance as possible is best, but there are also a number of funding options available that advisors can use to can help people address a sudden and immediate need for care.

Medicare 2023: What agents, clients need to know

As the 2023 open enrollment period for Medicare approached, advisors and their clients must be aware of some changes over previous years.

Among those changes: the coverage gap continues to get smaller, an increase in the number of disclosures agents must provide to clients, and a requirement that marketing and enrollment calls must be recorded.

Medicare Advantage projected annual premium decreases for 2023 plans

Medicare Advantage hit the headlines once again – this time with a look at projected annual premiums.

The projected average premium for 2023 Medicare Advantage plans declined nearly 8%, to $18 a month, from the previous year’s monthly $19.52, according to the Centers for Medicare & Medicaid Services. This follows a 10% decline in premiums in 2021.

At about the same time, however, CMS released the 2023 star ratings for MA and Part D plans that showed record declines in MA plans with high star ratings. CMS said 51% of MA plans with drug coverage would have a four-star rating or higher in 2023, a drop compared with 68% for 2022. It also found that 72% of people currently in an MA drug coverage plan are enrolled in one with four stars or higher, a drop from 90% for 2022.

‘The Great Unwinding’: What the pandemic’s end could mean for health coverage

An estimated 5.3 million to 14.2 million could lose their Medicaid coverage when the COVID-19 public health emergency ends. The end of the public health emergency will trigger what CMS calls “The Great Unwinding,” the undoing of many health coverage requirements and incentives put into place as a result of the COVID-19 public health emergency declaration and related legislation.  When the public health emergency declaration ends – which is expected to happen sometime in 2023 – millions of Americans are at risk for losing Medicaid or Affordable Care Act coverage.

Under the public health emergency declaration, more Americans became eligible for Medicaid. In addition, states were required to provide continuous coverage for those who were enrolled in Medicaid on or after March 18, 2020.

The public health emergency declaration gave the federal government the flexibility to waive or modify certain requirements in a number of areas, including Medicare, Medicaid, CHIP and private health insurance. In addition, Congress enacted legislation – The Families First Coronavirus Response Act and The Coronavirus Aid, Relief, and Economic Security Act – that provided additional flexibilities tied to the public health emergency. Those flexibilities end when the public health emergency ends.

Birth of LTCi: Fatal miscalculations spur decades of angst

LTCi is a perplexing product landscape. The need for the product is overwhelming, yet, insurers are busier trying to maintain old blocks of business that are actuarily unsound.

That means repeated rate requests in states across the country. It means reduced benefits. It means denying coverage to nearly half of applicants who most need it. Finally, it means some insurers have gone insolvent. Many others have left the LTCi business entirely.

Meanwhile, state insurance regulators struggle to weigh the needs of policyholders against the needs of insurers. It has pitted state against state in some instances.

Sarah Iselin looks ahead to new role leading Mass. BCBS

In 2023, Sarah Iselin, 51, will become the first female CEO of Blue Cross Blue Shield of Massachusetts, the state’s largest insurer with nearly 3 million members and $8 billion in revenue.

It is a critical time in health care in Massachusetts and elsewhere as institutions emerge from years of COVID-19, facilities are calling for higher reimbursements, and insurance and health care overall and becoming unaffordable for many.

Iselin, who served as the commissioner of the Massachusetts Division of Health Care Finance and Policy, was instrumental in creating Massachusetts' 2006 health care reform law, then dubbed RomneyCare, which became the model for the national Affordable Care Act, known as ObamaCare.

Nearly half applying for long-term care after 70 are denied, insurance group says

Adding to the crisis surrounding paying for long-term care is the fact that coverage is harder to obtain the older you get.

Nearly half of individuals who apply for traditional long-term care insurance after age 70 are denied by an insurer, according to the American Association for Long-Term Care Insurance. That’s because their health records disqualify them or the insurer simply doesn’t write policies for advanced-aged people.

According to Slome, nearly half of individuals who applied for traditional long-term care insurance between ages 70 and 75 were either declined or deferred their application. Over one-third of those applying between ages 65 and 69 were declined. The data comes from Association research as well as the just released 2022 Milliman LTC Survey.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at Susan.Rupe@innfeedback.com. Follow her on Twitter @INNsusan.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at susan.rupe@innfeedback.com.