The Biden Administration announced on its website recently that some changes will be made to the Direct Contracting Initiative in the Medicare program. Many have criticized the current program, but rather than terminate it altogether, the administration is changing its name to ‘Global & Professional Direct Contracting Model’ and adding certain protections against abuse.
If you currently have original Medicare and your medical providers select to participate in this model, you may get additional services aimed to help you stay healthy and better manage any chronic conditions. You may receive a letter in the mail informing you of this decision.
Some of the additional services/benefits provided include:
- Subsidizing payments for some Part-B covered services.
- The option to transfer to a skilled nursing facility without having to stay in the hospital for 3 days.
- More telehealth benefits.
- The ability to keep your current care if you already chose hospice care.
- Home visits from a health care provider after any hospital stays.
The purpose behind the initiative when it was originally introduced was to reduce costs and streamline care by allowing private health care providers to engage in risk-sharing with traditional Medicare. The Direct Contracting Entities (DCEs) are investors like private equity firms and private health insurance companies who receive a monthly payment for a specific group of patients. The less money spent on patient care, the more the investors make. DCEs are permitted to retain up to 40 percent of the money received as profit and overhead.
Based on this model, the system could be abused and harm patients, which is why new protections are being introduced alongside the name change. There will be more oversight, transparency and protections put in place for beneficiaries. With that said, there are still many who voice concerns that these protections will not be enough to guarantee patients receive the best care possible.
For more information on incorporating Medicare into your retirement planning and long-term care planning contact the knowledgeable attorneys at Stouffer Legal in the Greater Baltimore area. They will work with you to create a comprehensive plan that incorporates your long-term care needs and retirement goals into an overall estate plan. You can schedule an appointment by calling us at (443) 470-3599 or emailing us at office@stoufferlegal.com.
