Medicare Solutions Blog » medicare advantage plans

What Will the New Medicare Advantage Plan Ranking System Look Like?

Lucy Dylan — Thu, 01 Jul 2010 20:42:45 +0000

Susan Jaffe recently published a great read on Medicare Advantage plan ranking systems. Although the Advantage ratings purportedly help seniors weed out the best possible plans, the ratings system is flawed and most seniors rely on a combination of plan costs and benefits to determine which plan they want. The impending Medicare reforms will be rewarding top-ranked Advantage plans with bonuses, despite the obvious flaws within the system. The Center for Medicare Services (CMS) plans on using the current system at first, and later evaluating which factors work and which do not. Programs with 4 or 5 star ratings will receive higher bonuses from Medicare.

What will the new MAPD ranking system look like?

I feel that improving the ratings system is integral to Medicare reform. While costs and coverage are indeed incredibly important facets of every Advantage plan, quality of care and benefits are equally important for seniors. Relying on price alone may net a senior an affordable plan while sacrificing quality. Unfortunately, many seniors do rely on price. According to Jaffe, over 75% of Advantage plan beneficiaries select plans with less than 3 stars. Improving the ratings system can make seniors more aware of the quality of their Advantage plan, and possibly provide them with improved health care. Adding the incentive to perform better could ultimately help seniors out. However, that incentive needs to be clear and the ratings system needs to be solid.

Another part to the issue raised by Jaffe is that not all plans are rated, and not all areas boast 4 or 5 star rated plans. By expanding the ratings system, and breaking down all the benefits and coverage associated with the plan, perhaps CMS can provide more comprehensive analyses to facilitate Advantage plan selection for seniors. At the same time, plans need the opportunity to improve their ratings and quality. Improvement should be recognized as a factor in the ratings. Perhaps adding incentives for improvement in addition to overall rating might be helpful, although not necessarily cost-effective. By making providers accountable for their services and seniors more aware of the ins-and-outs of Advantage plans, perhaps there can be genuine improvements in the Medicare system.

At the same time, I feel that it might be difficult for the bonus system to work as it should, especially because standards of care vary across the country. Jaffe quotes Vicki Gottlich of the Center for Medicare Advocacy, who raises the concern that a simple average score might bury a plan’s deficiencies beneath its stronger points. And is it really fair to rate a 3 star plan in say, Idaho, to a 5 star plan in Florida? How can the rating system be most effective when there are so many variables involved?

Although the new bonuses may help improve the quality of care available for Medicare, CMS must ensure that all the wrinkles in the rating system are ironed out before applying the ratings to all plans. Perhaps a better path for CMS to follow would be to improve the ratings, helping out both consumers and providers, before analyzing each Medicare Advantage plan.

Avoiding Medicare Insolvency in 2016

Bill Stapleton — Fri, 08 Jan 2010 21:35:21 +0000

The recent Senate bill entitled “The Patient Protection and Affordable Care Act” is intended to bring insurance to many uninsured Americans and to help the Medicare program avoid insolvency, which is projected to happen in 6 years. Unfortunately, the bill will probably have just the opposite effect.

In addition to making draconian cuts to the Medicare Advantage program, the bill largely increases the number and cost of beneficiaries in Medicare. For example, both the House and Senate bills reduce the coverage gap, or “doughnut hole” in Part D coverage by $500 beginning in 2010. Other additions include increased benefits for dual Medicare-Medicaid eligible and eliminating cost-sharing for preventative services (beneficiaries will not have to pay for any of the cost). Such great cost reduction is certainly an enormous benefit for any senior, but puts a new strain on the need for more Medicare funds.

Additionally, the Senate bill plans to tax companies receiving prescription drug subsidies. Since 2003, companies that continued to provide their own prescription drug benefits qualified for a 28% tax-free subsidy (about $600 per year per retiree). The advantage for companies was the ability to list the subsidy as a reduction to their retiree health liability. The Senate bill will tax the subsidy, thus increasing companies’ tax liabilities and companies will be required to register the change as a loss in earnings.

The response expected from these companies will be to no long provide prescription drug benefits on their own. Thus, the cost falls back on Medicare who will see a dramatic increase in Part D beneficiaries. Increasing the number of Medicare eligibles will only add fuel to the fire: these change merely bring the day of reckoning for Medicare closer than 2016.

Senator Baucus and CMS Slam Humana

Bill Stapleton — Wed, 23 Sep 2009 13:39:13 +0000

In light of the recent letters sent out to their Medicare Advantage beneficiaries, insurance company Humana now faces the possibility of heavy fines and may even be kicked out of the Medicare Advantage market by federal healthcare agency, CMS. This seems like a pretty harsh penalty for a one page letter informing seniors that “health reform proposals being considered in Washington, D.C., this summer include billions in Medicare Advantage funding cuts” and that “millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable.” So why is CMS so up in arms?

At the urging of Senate Finance chairman Max Baucus who describes Humana’s letters as “mislead[ing] seniors regarding the subject,” CMS ordered Humana to stop sending out such letters. Both Baucus and CMS have put a warning to Humana and any other insurer that might get mixed up in health care reform politics, Baucus stating “it is wholly unacceptable for insurance companies to mislead seniors,” but, as the Wall Street Journal points out, “Humana merely made the mistake of trying to tell seniors the truth about what will happen to their coverage.”

CMS does not currently have a model for how insurance companies should respond to health care politics but, clearly, attempting to inform your current customers is not allowed. It should be noted that Humana has been extremely supportive of health care reform, save these changes to Medicare Advantage, despite all the fingers pointed at the insurance companies and their growing reputation as the “bad guys.” Finally, Humana attempts to defend itself through these letters, pointing out that if benefits were to be cut, it is not a consequence of Humana’s actions, but of the government. But Humana gets slammed.

Rather than arguing over words, Senator Baucus should set reimbursement levels for Humana and other managed care providers, so that they perform the way they were intended to! Save the government and taxpayers money, while offering high quality health plans. Humana should stop the clumsy PR campaign and defend their program with how they help taxpayers and beneficiaries—not simply scaring their members—be their claims true or not.

Medicare Doughnut Hole Closing

Annie Finneran — Fri, 26 Jun 2009 20:09:33 +0000

President Barack Obama announced on Monday that he plans on closing the gap in prescription drug coverage for senior citizens. The way that Medicare works now is that once a senior’s prescription drug costs reach $2,700, Medicare stops paying. Then once costs top $6,100, Medicare starts paying again. “It’s a reform that will make prescription drugs more affordable for millions of seniors … and restore a measure of fairness to Medicare Part D,” Obama said. Under the agreement, prescription drug costs would be cut in half for about 26 million seniors who fall into the so-called Medicare doughnut hole. Some people, however, are not so hopeful for this plan’s outcomes. “It signifies pretty much nothing,” said Michael Cannon, with the Cato Institute. “The pharmaceutical industry isn’t going to give out those discounts just for free. They’re expecting to get more customers. They’re expecting to make more money off this deal not less money,” Whatever the case may be, even if the pharmaceutical industry’s goals may be financial, it does not change the fact that this plan will help millions of seniors throughout the country pay for their prescriptions. Many seniors sufffer from the inability to pay for prescriptions under the doughnut hole and some are forced to drop their insurance. Sure, the pharameceutical companies may gain money through all of this, but as long as more seniors are covered with affordable prescription drug coverage, this plan is a success.

Some beneficiaries still have time to switch their Medicare coverage

Annie Finneran — Tue, 13 Jan 2009 17:50:16 +0000

Even though the annual Medicare enrollment period ended on December 31^st, some Medicare Advantage beneficiaries may still be able to switch their coverage during the current enrollment period which extends until March 31^st. Under certain circumstances, beneficiaries can change their plan by March 31 if they do not think the plan they chose fits their needs.

Of course there are some disadvantages. If, as of December 31 you have prescription drug coverage, you must continue to keep the coverage. If you did not have prescription drug coverage, you cannot add it to your plan.

The main reason why individuals may want to buy supplemental Medicare coverage is because Original Medicare offers limited coverage. Adding a supplemental plan, also add extra benefits, especially for those individuals with disabilities and pre-existing conditions. Medicare Advantage plans are required to cover any individual with pre-existing conditions.

Once the current enrollment is closed on March 31, beneficiaries have limited options to switching their coverage. There are only a few reasons that an individual may be able to change their plan. These specific reasons include:

Turning 65 after the open enrollment period is closed
As determined by the Social Security Administration, any individual can join a plan three months before or after their 25^th month of disability
Permanent home change is grounds for switching plans. If you move out of your plan’s service area, you’re eligible to switch plans.
If an individual move into or out of a nursing home, they can enroll in a new plan anytime during the specified year.

So if for any reason, you would like to switch your plan to best fit your needs, you still have time. Make sure you call your health insurance provider immediately to get the most out of your insurance.

Why choose a Health Net Medicare plan over its competitors’ plans?

Annie Finneran — Thu, 18 Dec 2008 20:00:33 +0000

Health Net is among the nation’s largest publicly traded managed health care companies. They provide health benefits to approximately 6.7 million individuals across the country through group, individual, Medicare, Medicaid and TRICARE and Veterans Affairs programs. They are the largest provider of Medicare Advantage plans in Connecticut and they have been serving Medicare Beneficiaries in Connecticut for 25 years offering their plans in all 8 counties.

Last year they introduced their “Take Care” program which features dedicated health care advocates for its Medicare members. It’s their dedication to the community that sets them apart from other health care companies. The “Take Care” Program offers access to Decision Power^SM, a 24/7 access to Health Coaches, tools, and materials that empower

members to learn more about their health conditions and treatments and to stay healthy. “Take Care” offers support such as coordinate care for complicated conditions and coordinated care when transitioning from a hospital to home, and discounts on wellness products and services.

Health Net’s “Take Care” program also offers flu shot, customer appreciation and community events. Some of the events include Senior Wii Bowling events and the Health Net Cup. These events are offered at senior centers throughout Connecticut.

Health Net has a high retention rate with 96% of their Medicare members renewing their Health Net plans each year. 29 out of the 30 hospitals in Connecticut are in the Health Net network and they were ranked 11^th nationally in the 4^th annual America’s Best Health Plans rankings. Health Net has 6 Medicare plans ranging in premiums from $0 to

$179 to meet a variety of needs. Many of their plans offer low or no copayments for physician or specialist office visits, low or no copayments for preferred medications, and optional supplemental benefits.

Some of their plans, with built in prescription drug plans, are The Navy Plan, The Ruby Plan options 1, 2, and 3, and The Sage Plan. A Medicare Advantage plan without a prescription drug program is The Green Plan, and 2 stand-alone prescription drug plans with drug coverage but no medical coverage is The Orange Plan, options 1 and 2.

The Navy Plan is a Point of Service (POS) plan with a monthly premium of $179 and $0 deductible. Primary doctor co-pays are $20 and specialist co-pays are $35. The Navy plan allows the flexibility of using doctor outside of the provider network.

The Ruby Plan provides cost effective medical and prescription drug coverage in one plan and is more affordable than most Medicare Supplement plans. Option 1 has a low monthly premium of $109 with a primary doctor co-pay of $10, a specialist co-pay of $20, and a $0 deductible. The Ruby Plan option 2 has both a $0 monthly premium and deductible but with a primary doctor co-pay of $20 and specialist co-pay of $30. The Ruby Plan option 3 has a low monthly premium of $59 and a $0 deductible. The primary doctor co-pay is $15 and the specialist co-pay is $25.

The Sage Plan has a monthly premium of $119 with a $0 deductible. Primary doctor co-pays are $10 and specialist co-pays are $20. The Sage Plan is Health Net’s chronic condition Special Needs Plan that comes with $0 copayments for generic drugs.

The Green Plan, a Medicare Advantage plan with no prescription drug program, offers both a $0 monthly premium and deductible. Primary doctor co-pays are $15 and specialist co-pays are $25. This is a cost-conscious plan for those with prescription drug benefits through another plan or if you have chosen not to have drug coverage.

The Orange Plan option 1, a separate prescription drug plan with no medical coverage, has a monthly premium of $31.70 and a $295 drug deductible. Option 2, also a stand-alone prescription drug plan, has a $46.20 monthly premium and no deductible. The Orange Plan is Health Net’s Medicare Part D Prescription Drug Plan that features commonly prescribed generic and brand name drugs.

So why choose Health Net’s Medicare Advantage plans over its competitors plans? They are a faithful service to many Medicare beneficiaries throughout Connecticut, they reach out to their community by planning fun and interactive events, and they offer a variety of Medicare Advantage Plans to meet as many situations as possible.

Have you enrolled in Medicare Part D yet?

Annie Finneran — Thu, 18 Dec 2008 19:54:19 +0000

The deadline for Medicare Part D enrollment is approaching fast so if you haven’t already, it’s time to review your current Medicare plan to make sure it still offers the same benefits and prescription drugs to meet your needs. Whether you want to change your current provider or you’re a new enrollee, you have until December 31 to enroll. Waiting until the last minute can cause you to face delays. This is a once a year opportunity that allows participants to choose among a variety of private insurance plans that can be custom tailored to their particular drug needs.

If you need help deciding what plan is best to fit your needs, there are many resources at your disposal to help during the open-enrollment period. In order to make an informed decision, you must know the basics first.

Medicare Advantage Prescription Drug Plans include Medicare Part A (hospital), Medicare Part B (doctor’s office visits), and Part D (prescription drug coverage). Medicare Part D plans only include prescription drug coverage and are usually purchased by people who already have Original Medicare (Part A and B).

Since the lists of covered drugs are changing as well as restrictions and costs, Medicare beneficiaries are being advised to review their current plans to make sure it will still benefit them in 2009. Because the enrollment period will soon come to a close, beneficiaries should review their plan and then begin viewing other plans and pricing. You should consider costs, doctors/providers, and travel when choosing a plan. Costs, such as premium, copayments, coinsurance, and deductible expenses, are changing. You also need to make sure that you’re able to visit the providers you want on your current plan and check to see if there will be additional costs if the provider is out of network or referrals are needed. You may also be travelling in the near future. Are you drugs covered if you travel to another state? You should make sure that your plan provides coverage in other states.

According to the Centers for Medicare and Medicaid (CMS), average monthly premiums for standard Part D coverage will be $28 in 2009, as opposed to the $25 in 2008.

What do you need to do when considering Medicare Part D plan?

1) Assess your needs. What prescription drugs are crucial to your life style?

2) Consult your doctor and pharmacist. Make sure they are still in your network under the plans you are considering.

3) Review all plans and prices to see which is best fit for you.

The Open Enrollment period for Medicare Part D ends on December 31^st which gives you two more weeks to make some very important decisions. Plans begin on January 1, 2009 and late charges and penalties may apply if you wait too long.