Sunday Links

The Secret to Your Success


Here’s an example what the public is hearing about the new “step-therapy” program for Medicare Advantage, via Forbes.

Tell your patients that if they don’t want their medication choices affected by step therapy, talk to their insurance agent about a plan that won’t require it.  They’ll have many options and they may want to pay less if the step therapy doesn’t affect their medication choices much.


Oncologists are “concerned” about medication step-therapy as well.

Chemo drugs shouldn’t be significantly affected, and if they are beneficiaries can just request a hardship change of policy waiver.  Another reason to have an “insurance home.”



How hard is it to earn top marks in STAR ratings?

Very hard, if you play by the rules.

Very easy if you keep two sets of books.




“Medicare Advantage” for all.

Very few people understand that the current “Medicare-for-all” proposal, by statute, expressly forbids privatizing Medicare and would completely eliminate the Medicare Advantage program.

Medicare Advantage for all is an intriguing idea, but not until the massive fraud is squeezed out and real compliance enforcement is in place.




5 Million housecalls last year for Medicare Advantage patients

Just wait until next year when you don’t have to be seriously ill to qualify, that number will skyrocket.





Restricting Medicare Advantage patient’s opioid coverage if their use identifies them as outliers

When the government pays for care, all care decisions become political.  Not necessarily good or bad—but a reality that needs to be considered.




“The physicians who do the best under Medicare Advantage are the ones who offer the broadest spectrum of services in their own office.”