Medicare Advantage 2014 Spotlight: Enrollment Market Update 

Despite concerns that payment changes enacted in the Affordable Care Act of 2010 (ACA) would lead to reductions in Medicare Advantage enrollment, the number and share of Medicare beneficiaries enrolling in Medicare Advantage plans has continued to climb. 1 Since the enactment of the ACA, Medicare Advantage enrollment has increased by 4.6 million, or by 41 percent. 2 Reductions in payments enacted in the ACA aimed to reduce historical overpayments to Medicare Advantage plans and to create more equity between Medicare payments made for beneficiaries in the traditional Medicare program and those joining Medicare Advantage plans. As of March of 2014, almost one in three (30 percent) people on Medicare (15.7 million beneficiaries) were enrolled in a Medicare Advantage plan, a 10 percent increase since March 2013.During the past year, Medicare Advantage enrollment has increased in virtually all states. Most of the enrollment growth since 2013 has been in the individual market, but group enrollment in Medicare Advantage plans accounted for almost one-third (32%) of the enrollment growth in 2014 and has been a major factor in the experience of some firms.

Average monthly premiums (weighted by enrollment) have remained relatively stable since 2012 ($35 per month in 2014).   During this same period, however, average out-of-pocket spending limits have been on the rise, which could expose a subset of enrollees to higher costs mainly those who have significant medical needs.   Medicare Advantage plans, unlike traditional Medicare, are required to limit out-of-pocket costs for services covered under Parts A and B ($3,400 is recommended; $6,700 is the maximum).   Between 2013 and 2014, the share of Medicare Advantage enrollees in plans with limits above $5,000 almost doubled, from 24 percent in 2013 to 44 percent in 2014. This Data Spotlight reviews national and state-level enrollment trends as of March 2014 and examines variation in enrollment by plan type and firm. It also analyzes the most recent data on premiums, out-of-pocket limits and prescription drug coverage in the Part D donut hole for Medicare Advantage enrollees.

 

Medicare Advantage 2014 Spotlight: Enrollment Market Update 

Secretive Reviews Target 30 Medicare Advantage Plans

Secretive Reviews Target 30 Medicare Advantage Plans

Fred Schulte, Center for Public Integrity Monday, 9 Jun 2014 | 10:33 AM ET NBC News SHARES

This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.

After years of criticism that they cost taxpayers too much, private Medicare Advantage health plans are facing landmark audits that for the first time could order them to repay the government tens of millions of dollars for past overcharges and other billing mistakes.

Medicare pays the health plans a set amount monthly for each person based on estimates known as”risk scores” of how sick they are. The industry has grown explosively over the past decade under this payment method and now cares for nearly 16 million people at a cost expected to top $150 billion this year.
Getty Images Marilyn Tavenner, Administrator at the Centers for Medicare and Medicaid Services

The government audits are targeting chronic Medicare Advantage billing errors that federal officials blame for billions of dollars in”improper” payments every year mainly due to inflated estimates of the health”risks” of the seniors the plans insure. The findings carry added importance because insurers selling policies on exchanges set up under the Affordable Care Act will be paid under a similar risk-based formula, which officials expect to reduce overall health care expenditures.

The secretive audit process is known as Risk Adjustment Data Validation, or”RADV,” in Washington parlance. In early November 2013, federal officials notified 30 health plans that they had been selected for review this year. Officials declined to name the companies or discuss the audit process. So it's not clear if any of these audits have yet been completed, or what the results might be. 

The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly conducted some of these RADV (pronounced RAD'-vee) audits since 2008. But the agency has never before imposed stiff financial penalties for overbilling the government, as it now intends to do. In the first round of audits, officials expect to recoup as much as $370 million from overpayments allegedly made to the 30 Medicare Advantage plans during 2011, according to CMS.

However, that figure is well below previous administration estimates, and health plans have been granted extensive appeal rights that could stall any repayment orders for years.

Read the Center for Public Integrity's version of this article

CMS is part of the Department of Health and Human Services (HHS). The HHS Office of Inspector General, which acts as a watchdog over CMS, has done some of its own audits of Medicare Advantage. It estimated much higher losses in six plan audits it conducted starting late in 2008. Those audits found that just the six plans reviewed had been overpaid by as much as $650 million for 2007 alone because of inflated risk scores, including payments for diseases that couldn't be verified through a patient's medical record.

The HHS inspector general audits are more worrisome to the industry than the CMS audits because the findings are made public and often draw media notice and attention from members of Congress. But the inspector general's office has said it won't be conducting any more of its reviews for the foreseeable future due to budget cuts, leaving oversight in the hands of CMS.

Medicare Advantage is too big now: Aetna CEO 

Mark Bertolini, Chairman, Chief Executive Officer and President of Aetna, discusses the government's Medicare program and weighs in on enrollment participation in Obamacare. I think too much is being made of the website, we all have website failures from time to time, Bertolini says.

CMS officials have said that health plans would be selected for review this year based”primarily” on changes in risk scores, presumably increases.

Humana Inc., one of the nation's largest Medicare Advantage plans with more than 2.7 million members, notified investors in February that one of its contracts had been chosen. The company did not elaborate.

Florida Blue Cross also has notified its doctors that the plan was among the 30 selected for review this year, and indicated that it wanted doctors to cooperate.

Samaritan Health Plan, based in central Oregon with 6,500 members, also was picked, according to a company newsletter. Health Net, Inc. disclosed in a Securities and Exchange Commission filing that its plan in Arizona was selected. None of the health plans would comment.

Read More AMA challenges accuracy of Medicare data dump

At issue is the accuracy of”risk scores” used since 2004 to pay the health plans. At the time, Congress hoped to spur the growth of these insurance plans by adjusting payments based on how likely their enrollees were to need costly medical services.

The health plans collect medical data used to compute a”risk score” for each person they enroll and Medicare pays them higher rates for sicker people and less for those in sound health.

Medicare millionaires: Behind the numbers

CNBC's Scott Cohn reports on new data released by the Department of Health and Human Services showing Medicare doctors claiming millions of dollars.

But the risk-scoring formula has proven to be a breeding ground for billing irregularities as much as $70 billion in”improper” payments to health plans from 2008 through the end of last year, according to government sampling data reviewed by the Center for Public Integrity.

Click here to see how changes to a risk score can boost costs

Mary Inman, a San Francisco lawyer who represents whistleblowers, said officials have been concerned for years that risk scores if abused could offer a”new way to fleece” the Medicare program.”This is a weak spot for CMS,” she said, noting that it”hasn't hit the public realm yet.”

The CMS RADV audits, which CMS conducts to determine whether the health plans have been paid correctly, will probe whether health plans trigger overpayments by reporting diseases that don't have any impact on health and medical care, or by exaggerating the severity of conditions in effect making patients look sicker on paper than they actually are. Doing that leads Medicare to pay a plan more money than it deserves.

Maria Gonzalez Knavel, a health care attorney in Milwaukee, said that if insurers have been reporting risk scores accurately, the impact of these audits will be minimal. But if they reveal a lot of”loose” reporting,”that will be a whole different ball game,” she said.

Read More Real Medicare waste? Uncle Sam stayed mum too long

Gonzalez Knavel said there's a perception in the industry that billing errors occur with some frequency.”They're humans and they don't always get it right,” she said.”There will be some mistakes made.”

When mistakes are made, risk scores are far more likely to be too high than too low, government records show. Nearly 80 percent of the improper payments in 2013 $9.3 billion were overcharges, according to the data sampling.

Whether Medicare Advantage plans are a good deal for taxpayers has been a contentious, and often highly political, question in Washington for years. Many critics, particularly Democrats in Congress, argued that the health plans marketed to healthier seniors and inflated risk scores to boost profits.

Click here to see the Center for Public Integrity's Medicare Advantage explainer

“That makes enrollees look less healthy without any actual change in health status and drives up payments to plans,” Rep. Henry Waxman, then chairman of the House Energy and Commerce Committee, wrote in a March 6, 2009, letter to a top Medicare official. The letter was signed by four other senior Democrats as well.

The Center for Public Integrity's independent analysis of government data confirmed that in 2011 more than 800,000 patients across the country were enrolled in Medicare Advantage plans that the government paid at per-patient rates at least 25 percent higher than the average under the more common traditional Medicare option run by the government.

Hands off Medicare and Social Security: Union

Organized labor is making it clear it opposes any idea involving social security, Medicare and Medicaid cuts. Damon Silvers of AFL-CIO, shares his opinions.”We are not going to give cover to Democrats who think it's a good idea to take away economic security to our most vulnerable citizens,” he says.

A note on the Center's methodology

Supporters counter that the health plans offer extra benefits, such as dental care and hearing aids, and can cost seniors less in out-of-pocket expenses than standard Medicare, a major selling point.

Cutting back on overpayments to Medicare Advantage plans has been a priority for the Obama administration. With the support of some key Democrats in Congress, the administration had hoped to use some of the savings for the Affordable Care Act.

Still, the Obama administration has taken years to get the new round of RADV audits underway amid criticism from the industry over the details. Group Health, a non-profit plan that operates in Washington state and Idaho, argued in a December 2009 letter to CMS that the audit process”could seriously jeopardize the future viability of the Medicare Advantage program.”

Read More Medicare on drugs: 24,000 tests for 145 patients

While the reasons are not clear, over time CMS has scaled back the amount of money it expects to recoup from the audits.

In testimony before Congress in March 2010, an administration official predicted the audits would result in $7.6 billion in savings over a decade. A year later that figure had shrunk to $6.1 billion over the same period. In late February 2012, the agency simply stated that it expected to collect $370 million in the first year.

“Fighting fraud, improving payment accuracy and saving money for Medicare is one of our top priorities,” CMS Administrator Marilyn Tavenner said in a February 2012 prepared statement.

Industry consultant John Gorman said that he believes CMS may be disappointed in what it finds.

“It's pretty clear that this is a substantial revenue collection exercise for the government,” Gorman said.”They clearly think there is a pot of gold at the end of the rainbow.”

Gorman said officials are likely to find some Medicare Advantage plans that can't produce adequate documentation of the diseases they billed for, but any shortcomings are the result of the complexity of billing, not abuse or fraud, he believes.

The Center for Public Integrity is a nonprofit, nonpartisan investigative news organization in Washington, D.C.

By Fred Schulte, Center for Public Integrity

Secretive Reviews Target 30 Medicare Advantage Plans

Do patients choose Medicare Advantage for convenience?

Having just retired on July 1st, my medical group's commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap.

I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has been nothing short of an eye-opener. I should have of course known better, embarking on any venture with a government agency. I signed up online for Medicare Part A, but Part B was more challenging since I didn't want to start collecting Social Security at the same time and the computer program didn't like this.

There is of course Medicare Part A, which covers hospital bills, and Medicare Part B that covers other medical and physician service. Then there is Part D that is the drug prescription plan.  Medicare HMO's combine A, B and D for one set fee and are known as Medicare Part C, or Medicare Advantage. However, hospital, physician, and drug choices are severely limited when signing up for Part C, no matter what the insurance company's marketing advertises. Medigap plans can be purchased to fill in the many holes which A and B do not cover, for another premium. This is also called Medicare Part F. Are you still with me?

Now there is also Medicare Parts E, G, H, I, J, K and L. But let's skip those for now. By late spring of this year, my head was spinning. I threw in the towel and used an insurance expert to help me navigate this alphabetical morass. Within the past two months, hardly a day would pass without some document arriving form Medicare, Social Security, or United Healthcare, the private insurance company that I had chosen for my Part D and F plans. Thankfully, they have an almost 24/7 telephone help line. I was told in writing no less than three times that my Medicare Part B would be higher than normal due to my high previous year's income. I was asked in writing to verify, in writing, why I hadn't applied for Medicare Part D benefits from the start of the year.

My epiphany was that many of my former patients probably chose Medicare Part C or HMO plans, not just to save money, but also not to have to deal with this endless maze of paperwork and redundancy. This system is so cumbersome, arbitrary, and difficult to understand that only another government agency, the IRS, can make it look simple.

I have come to the conclusion that navigating all of these arms of the Medicare tendrils is almost a full time job. I have a much better appreciation for what my patients have had to endure all these years while I was simply trying to diagnose and treat their heart disease. It is no wonder our Medicare system is such a mess.

David Mokotoff is a cardiologist who blogs at  Cardio Author Doc.  He is the author of  The Moose's Children: A Memoir of Betrayal, Death, and Survival.  

Do patients choose Medicare Advantage for convenience?

Impact Of Medicare Advantage Cuts On Seniors Sharply 

Seniors enrolled in Aetna's Medicare Advantage plan In Baltimore County, Md., saw their monthly premiums rise from $33 to $51 this year.

Enrollees in HealthNow New York, a Medicare HMO in upstate Erie County, saw their premiums jump from zero to $28 a month.

Those in UnitedHealthcare's plan in Cuyahoga County, Ohio, pay $15 more to see a specialist this year, bringing their total co-pay to $45.

The health insurance industry points to these examples as some of the more extreme cases of beneficiaries feeling the sting of federal funding cuts to Medicare Advantage plans that cover nearly 16 million senior citizens. They say the Obama administration's additional proposed 1.9 percent in cuts to the plans for 2015, which was announced Friday, will mean millions more will see reductions in benefits and higher out-of-pocket costs.

But health policy experts and advocates for seniors say most Medicare health plans have largely kept costs and benefits stable and believe the industry is scaring seniors unnecessarily.

Is The Sky Falling?

Medicare Advantage Cuts

Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments

Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed

We have really overall had a rather calm year so the sky is falling' predictions from the health insurance industry did not come true, said Joe Baker, president of the Medicare Rights Center, a consumer advocacy group.

The announcement of the government's proposed reimbursements for the private Medicare plans, which now cover a third of all Medicare beneficiaries, has become an annual battle since the passage of the Affordable Care Act, which gradually reduces subsidies paid to Medicare Advantage plans to bring them into line with the cost of traditional Medicare.

Last year, for instance, the administration initially proposed cuts of 2.2 percent for 2014. After a campaign by insurers that included paid advertising and letters from scores of lawmakers, the government reversed course and increased the rate 3.3 percent.

Health plans say those stated rates are misleading, however, because they don't tell the full story. They argue that when other factors are taken into account, such as Medicare cuts made as a result of budget sequestration and the health law's tax on health insurance premiums and reduction in subsidies, Medicare Advantage plans actually saw more than a 6 percent cut this year. And, they say there will be even higher cuts next year if the administration's proposed rate is adopted.

Another round of payment cuts would be devastating to… seniors and people with disabilities that have chosen to enroll in Medicare Advantage for the better benefits and higher quality coverage these plans provide, said Karen Ignagni, CEO of the trade group, America's Health Insurance Plans.

Despite similar predictions last year, enrollment is still rising overall in the private plans up nearly 9 percent this year.

Geography Matters

And in many parts of the country, such as South Florida and New York, seniors can still choose health plans with no monthly premiums.

A growing number of Medicare beneficiaries have chosen to enroll in Advantage plans, often to reduce their out-of-pocket spending as traditional Medicare generally covers only 80 percent of the cost of most doctor and outpatient care. In addition, the plans often offer extra benefits, such as hearing aids or gym memberships, which are not available in traditional Medicare.

The flip side is that beneficiaries must seek care from physicians, hospitals and other providers that contract with those plans to be in their networks. Traditional fee-for-service allows beneficiaries to visit any doctor or provider that accepts Medicare.

Over the next few years, the health law will continue to reduce payments to Medicare Advantage plans until they are in line with the cost of traditional Medicare. Independent advisors to Congress have said that seniors in traditional Medicare are subsidizing the higher costs of those in private plans.

These payment cuts are also helping to fund expanding coverage to millions of uninsured Americans, under the Affordable Care Act. The savings are part of the way to balance the books, to help pay for subsidies to people buying plans on the health insurance exchanges.

David Lipschutz, policy attorney with the Center for Medicare Advocacy, said Medicare costs have been rising at their lowest levels in decades and Medicare Advantage plans should not be insulated from those forces.

Health plans make business decisions each year on prices and benefits and this year is no different, he said. The health insurance industry is trying to use a lot of confusion on this payment issue, but we are unaware of any new trends in changes in benefits, Lipschutz said.

Len Pursiano, who counsels seniors in Bergen County, N.J., for the State Health Insurance Assistance Program, a consumer help program, said seniors were upset this year when two area health plans eliminated their zero-premium plans and required them to pay more than $145 per month. A third insurer, UnitedHealthcare, maintained its zero premium plan, but reduced the number of doctors in its network.

In fact, UnitedHealthcare, the largest Medicare Advantage insurer in the country with more than 3 million members, dramatically reduced number of doctors in its plans in 10 states this year, many of them in the Northeast.

You Better Shop Around

Consumer advocates say Medicare Advantage works only if seniors shop for a new plan each year because the plans change so often. But too often, seniors stay with same plan which leads them to pay more than they need to.

Bill Daniels, coordinator of insurance at the Erie County Department of Senior Services, said the costs and benefits change each year, though most seniors choose the plans with zero premiums.

Of insurers' predictions that things will worsen next year, he said: Seniors can still choose from zero premium plans and new plans are entering the market.

Health plans don't disclose how much money they make from marketing Medicare Advantage plans. Overall, United Healthcare made a $10 billion profit last year on $122 billion in revenues. Company officials say Medicare is only one part of its business.

Still, Kim Reyes, who counsels seniors in Greenville, S.C. for the State Health Insurance Assistance Program says seniors are hyper-vigilant about any changes in their costs or benefits. Some folks count every penny, she said.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Impact Of Medicare Advantage Cuts On Seniors Sharply 

Impact Of Medicare Advantage Cuts On Seniors Sharply 

Seniors enrolled in Aetna's Medicare Advantage plan In Baltimore County, Md., saw their monthly premiums rise from $33 to $51 this year.

Enrollees in HealthNow New York, a Medicare HMO in upstate Erie County, saw their premiums jump from zero to $28 a month.

Those in UnitedHealthcare's plan in Cuyahoga County, Ohio, pay $15 more to see a specialist this year, bringing their total co-pay to $45.

The health insurance industry points to these examples as some of the more extreme cases of beneficiaries feeling the sting of federal funding cuts to Medicare Advantage plans that cover nearly 16 million senior citizens. They say the Obama administration's additional proposed 1.9 percent in cuts to the plans for 2015, which was announced Friday, will mean millions more will see reductions in benefits and higher out-of-pocket costs.

But health policy experts and advocates for seniors say most Medicare health plans have largely kept costs and benefits stable and believe the industry is scaring seniors unnecessarily.

Is The Sky Falling?

Medicare Advantage Cuts

Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments

Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed

We have really overall had a rather calm year so the sky is falling' predictions from the health insurance industry did not come true, said Joe Baker, president of the Medicare Rights Center, a consumer advocacy group.

The announcement of the government's proposed reimbursements for the private Medicare plans, which now cover a third of all Medicare beneficiaries, has become an annual battle since the passage of the Affordable Care Act, which gradually reduces subsidies paid to Medicare Advantage plans to bring them into line with the cost of traditional Medicare.

Last year, for instance, the administration initially proposed cuts of 2.2 percent for 2014. After a campaign by insurers that included paid advertising and letters from scores of lawmakers, the government reversed course and increased the rate 3.3 percent.

Health plans say those stated rates are misleading, however, because they don't tell the full story. They argue that when other factors are taken into account, such as Medicare cuts made as a result of budget sequestration and the health law's tax on health insurance premiums and reduction in subsidies, Medicare Advantage plans actually saw more than a 6 percent cut this year. And, they say there will be even higher cuts next year if the administration's proposed rate is adopted.

Another round of payment cuts would be devastating to… seniors and people with disabilities that have chosen to enroll in Medicare Advantage for the better benefits and higher quality coverage these plans provide, said Karen Ignagni, CEO of the trade group, America's Health Insurance Plans.

Despite similar predictions last year, enrollment is still rising overall in the private plans up nearly 9 percent this year.

Geography Matters

And in many parts of the country, such as South Florida and New York, seniors can still choose health plans with no monthly premiums.

A growing number of Medicare beneficiaries have chosen to enroll in Advantage plans, often to reduce their out-of-pocket spending as traditional Medicare generally covers only 80 percent of the cost of most doctor and outpatient care. In addition, the plans often offer extra benefits, such as hearing aids or gym memberships, which are not available in traditional Medicare.

The flip side is that beneficiaries must seek care from physicians, hospitals and other providers that contract with those plans to be in their networks. Traditional fee-for-service allows beneficiaries to visit any doctor or provider that accepts Medicare.

Over the next few years, the health law will continue to reduce payments to Medicare Advantage plans until they are in line with the cost of traditional Medicare. Independent advisors to Congress have said that seniors in traditional Medicare are subsidizing the higher costs of those in private plans.

These payment cuts are also helping to fund expanding coverage to millions of uninsured Americans, under the Affordable Care Act. The savings are part of the way to balance the books, to help pay for subsidies to people buying plans on the health insurance exchanges.

David Lipschutz, policy attorney with the Center for Medicare Advocacy, said Medicare costs have been rising at their lowest levels in decades and Medicare Advantage plans should not be insulated from those forces.

Health plans make business decisions each year on prices and benefits and this year is no different, he said. The health insurance industry is trying to use a lot of confusion on this payment issue, but we are unaware of any new trends in changes in benefits, Lipschutz said.

Len Pursiano, who counsels seniors in Bergen County, N.J., for the State Health Insurance Assistance Program, a consumer help program, said seniors were upset this year when two area health plans eliminated their zero-premium plans and required them to pay more than $145 per month. A third insurer, UnitedHealthcare, maintained its zero premium plan, but reduced the number of doctors in its network.

In fact, UnitedHealthcare, the largest Medicare Advantage insurer in the country with more than 3 million members, dramatically reduced number of doctors in its plans in 10 states this year, many of them in the Northeast.

You Better Shop Around

Consumer advocates say Medicare Advantage works only if seniors shop for a new plan each year because the plans change so often. But too often, seniors stay with same plan which leads them to pay more than they need to.

Bill Daniels, coordinator of insurance at the Erie County Department of Senior Services, said the costs and benefits change each year, though most seniors choose the plans with zero premiums.

Of insurers' predictions that things will worsen next year, he said: Seniors can still choose from zero premium plans and new plans are entering the market.

Health plans don't disclose how much money they make from marketing Medicare Advantage plans. Overall, United Healthcare made a $10 billion profit last year on $122 billion in revenues. Company officials say Medicare is only one part of its business.

Still, Kim Reyes, who counsels seniors in Greenville, S.C. for the State Health Insurance Assistance Program says seniors are hyper-vigilant about any changes in their costs or benefits. Some folks count every penny, she said.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Impact Of Medicare Advantage Cuts On Seniors Sharply 

Viewpoints: 'Entitlement Meltdown;' Improving Medicare Advantage

Jul 22, 2014

The Wall Street Journal: Heading Off The Entitlement Meltdown
Each day, 10,000 baby boomers retire and begin receiving Medicare and Social Security benefits. And while five workers supported the benefits of each retiree in 1960, there will be only two workers funding each retiree by 2030. Those who dismiss long-term budget projections should re-read the last paragraph. The retirement of 77 million baby boomers into Social Security and Medicare is not a theoretical projection. Demography is destiny (Sen. Rob Portman, R-Ohio, 7/21). 

The New York Times' The Upshot: Medicare Advantage Is Not Efficient, But Here's How It Can Be
Medicare Advantage plans private plans that serve as alternatives to the traditional, public program have been growing in popularity. One reason is that they offer additional benefits beyond those available in the traditional program but often at no additional cost to beneficiaries. This is a great deal for beneficiaries, but a bad one for taxpayers, who have to cover the extra cost. If the program were reorganized to more closely resemble the Affordable Care Act's exchanges, it could still provide good value to consumers at a lower cost to taxpayers (Austin Frakt, 7/21). 

The New York Times Magazine: What The Hobby Lobby Ruling Means For America
Last month, as you've probably heard, a closely divided Supreme Court ruled that corporations with religious owners cannot be required to pay for insurance coverage of contraception. The so-called Hobby Lobby decision, named for the chain of craft stores that brought the case, has been both praised and condemned for expanding religious rights and constraining Obamacare. But beneath the political implications, the ruling has significant economic undertones. It expands the right of corporations to be treated like people, part of a trend that may be contributing to the rise of economic inequality (Binyamin Appelbaum, 7/22). 

Los Angeles Times: A CDC Safety Net Full Of Holes
The recent safety lapses at the Centers for Disease Control and Prevention might have been chalked up to the sloppy work habits of a few employees, easily resolved, if it weren't for the revelation last week that there has in fact been a systemic problem with laboratory safety for a number of years. These problems, involving dangerous pathogens, have been uncovered both at CDC laboratories and at other laboratories around the country that are overseen by the CDC. The problems could easily have endangered human lives (7/21). 

Bloomberg: How Civil-Rights Law Could Overturn Hobby Lobby
Employers who single out contraceptives as undeserving of coverage don't only violate ethical expectations of gender equality. They also violate federal anti-discrimination law. Title VII of the Civil Rights Act of 1964 prohibits employers from discriminating on the basis of sex, including enacting policies that, while gender-neutral on their face, disproportionately hurt either men or women…. The Hobby Lobby decision did not address Title VII simply because the court wasn't asked to…. Nonetheless, the justices should have considered the anti-discrimination law on the books. By ignoring the discriminatory aspects of the denials, the Hobby Lobby majority was able to argue that the government's interest in protecting contraceptive access could not sustain the Religious Freedom Restoration Act challenge mounted by the objecting corporations (Alexandra Brodsky and Elizabeth Deutsch, 7/21).

Charlotte Observer: Tackling Medicaid In North Carolina
We don't know if Gov. Pat McCrory was sincere or not when he said last week that he's open to expanding Medicaid once a plan is in place to fix its unpredictable cost problems. But it was good to hear. … A recent (Raleigh) News & Observer series showed that parts of the N.C. Medicaid program work. Costs per person have decreased as spending nationally has gone up. More providers in the state, compared with the national rate, are willing to participate. And services are better, especially preventive care, than in many other states. An overhaul that throws out all that good to fix the bad is wrongheaded. We hope lawmakers can reach agreement on a plan that doesn't do that. We also hope they, like McCrory, will keep the door open or rather open it again on expansion (7/20).

This is part of Kaiser Health News' Daily Report – a summary of health policy coverage from major news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Viewpoints: 'Entitlement Meltdown;' Improving Medicare Advantage

Medicare Advantage Fact Sheet 

Since the 1970s, Medicare beneficiaries have had the option to receive their Medicare benefits through private health plans, mainly health maintenance organizations (HMOs), as an alternative to the federally administered traditional Medicare program.  The Balanced Budget Act (BBA) of 1997 named Medicare's managed care program Medicare+Choice and the Medicare Modernization Act (MMA) of 2003 renamed it Medicare Advantage.   Medicare payments to plans are projected to total $156 billion in 2014, accounting for 30% of total Medicare spending (CBO April 2014 Medicare Baseline).

Over the past decades, Medicare payment policy for plans has shifted from one that produced savings to one that focused more on expanding access to private plans and providing extra benefits to Medicare private plan enrollees.  These policy changes resulted in Medicare paying private plans more per enrollee than the cost of care for beneficiaries in traditional Medicare, on average (MedPAC 2010). The Affordable Care Act (ACA) of 2010 produced another shift in payment policy by reducing federal payments to Medicare Advantage plans over time, bringing them closer to the average costs of care under the traditional Medicare program. It also provided for new bonus payments to plans based on quality ratings, beginning in 2012, and required plans beginning in 2014 to maintain a medical loss ratio of at least 85%, restricting the share of premiums that Medicare Advantage plans can use for administrative expenses and profits.

Medicare Advantage Enrollment

In 2014, the majority of the 54 million people on Medicare are in the traditional Medicare program, with 30% enrolled in a Medicare Advantage plan ( Exhibit 1 ).  Since 2004, the number of beneficiaries enrolled in private plans has almost tripled from 5.3 million to 15.7 million in 2014.

Exhibit 1. Total Medicare Private Health Plan Enrollment, 1999-2014

Enrollment in private plans varies by state, ranging from 51% in Minnesota to less than 1% in Alaska, and vary within states, by county ( Exhibit 2 ).

Exhibit 2. Share of Medicare Beneficiaries Enrolled in Medicare Advantage Plans, by State, 2014

Medicare Advantage Plan Types

Medicare contracts with insurers to offer the following different types of health plans:

Local HMOs and PPOs contract with provider networks to deliver Medicare benefits.  HMOs account for the majority (64%) of total Medicare Advantage enrollment in 2014; local PPOs, account for 23% of all Medicare Advantage enrollees ( Exhibit 3 ).

Exhibit 3. Distribution of Enrollment in Medicare Advantage Plans, by Plan Type, 2014

Regional PPOs were established to provide rural beneficiaries greater access to Medicare Advantage plans, and cover entire statewide or multi-state regions.  Regional PPOs account for 8% of all Medicare Advantage enrollees in 2014.

Private Fee-for-Service plans (PFFS), as authorized in 1997, were not required to establish networks, but since 2011, have generally been required to do so. PFFS enrollment increased ten-fold from 0.2 million enrollees in 2005 to 2.2 million 2009, but has since declined to 0.3 million enrollees in 2014, or 2% of all Medicare Advantage enrollees.

Other types of private plans (e.g., cost plans, HCPP, PACE plans, medical savings accounts, demonstrations and pilots) account for 3% of private plan enrollment. In a small number of states (e.g., MN), a large percentage of private plan enrollment is in cost plans, which are paid based on the reasonable cost of providing services and, unlike Medicare Advantage plans, do not assume financial risk if federal payments do not cover their costs.

Special Needs Plans (SNPs), typically HMOs, are restricted to beneficiaries who: (1) are dually eligible for Medicare and Medicaid; (2) live in long-term care institutions (or would otherwise require an institutional level of care); or (3) have certain chronic conditions.  Since 2006, the number of SNP enrollees has increased from 0.5 million to 1.9 million enrollees in 2014; enrollment in SNPs for dual eligibles accounts for 82% of total enrollment in SNPs.

Payments To Medicare Private Plans

Medicare pays Medicare Advantage plans a capitated (per enrollee) amount to provide all Part A and B benefits.  In addition, Medicare makes a separate payment to plans for providing prescription drug benefits under Medicare Part D.  Prior to the BBA of 1997, Medicare paid plans 95% of average traditional Medicare costs in each county because HMOs were thought to be able to provide care more efficiently than could be provided in traditional Medicare.  These payments were not adjusted for health status, and HMOs typically enrolled beneficiaries who were healthier than average.

Beginning in the late 1990s, Congress revised the payment formula to attract more plans throughout the country, particularly in rural and certain urban areas. The BBA of 1997 established a payment floor, applicable almost exclusively to rural counties.  The Benefits Improvement and Protection Act (BIPA) of 2000 created payment floors for urban areas and increased the floor for rural areas.  The MMA of 2003 increased payments across all areas.

Since 2006, Medicare has paid plans under a bidding process.  Plans submit bids based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan's bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan's share is known as a rebate, which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees' risk profiles.

The ACA of 2010 revised the methodology for paying plans and reduced the benchmarks. For 2011, benchmarks were frozen at 2010 levels.  Reductions in benchmarks will be phased-in over 2 to 6 years between 2012 and 2016.  By 2017, when the new benchmarks are fully phased-in, the benchmarks will range from 95% of traditional Medicare costs in the top quartile of counties with relatively high per capita Medicare costs (e.g., Miami-Dade), to 115% of traditional Medicare costs in the bottom quartile of counties with relatively low Medicare costs (e.g., Boise).

The ACA specified that plans with higher quality ratings would receive bonus payments added to their benchmarks, beginning in 2012.  The ACA also reduced rebates for all plans, but allowed plans with higher quality ratings to keep a larger share of the rebate than plans with lower quality ratings.  A CMS demonstration was implemented in 2012 that superseded bonuses specified by the ACA, raised the size of the bonus payments, and increased the number of plans that would receive bonus payments, providing an additional $8 billion in bonuses between 2012 and 2014.

Supplemental And Prescription Drug Benefits

Medicare Advantage plans are paid to provide all Medicare benefits.  In addition, if they receive rebates, they are required to use these payments to provide additional benefits, such as eyeglasses, or reduce premiums or cost sharing for covered benefits.  Medicare Advantage plans are generally required to offer at least one plan that covers the Part D drug benefit.  In 2014, 83% of Medicare Advantage plans offer prescription drug coverage, and 50% provide some coverage in the gap.  All Part D enrollees receive a 50% discount on brand-name drugs in the gap, beginning in 2011.  Since 2011, all plans have been required to limit beneficiaries' out-of-pocket spending to no more than $6,700.

Medicare Advantage Premiums

The average premium for enrollees of Medicare Advantage Prescription Drug plans will be $35 per month in 2014, similar to premiums in 2013 and 2012. Premiums were lower for HMOs and regional PPOs than for local PPOs and PFFS plans; we do not know whether cost sharing for individual services has changed and thus do not know to what extent enrollees' out-of-pocket expenses have changed ( Exhibit 4 ).

Exhibit 4. Weighted Average Monthly Premiums for Medicare Advantage Prescription Drug Plans, Total and by Plan Type, 2010-2014

Future Issues

Historically, Congress has enacted a number of changes that affect the role of private plans under Medicare, including adding new types of plans to the program, increasing or decreasing Medicare payments to plans, tightening the rules governing the marketing of the plans, and even changing the name of the program (from Medicare+Choice to Medicare Advantage ).  The Affordable Care Act of 2010 made a number of changes to the Medicare Advantage program, driven largely by concerns about the payment system and its effect on Medicare spending.

In 2014, Medicare Advantage markets and plans will look much as they did in 2013, in terms of the number of plans available to beneficiaries.  Over the longer term, companies offering Medicare Advantage plans may respond to payment changes in several different ways, depending on the circumstances of the company, the location of their plans, their historical commitment to the Medicare market, their ability to leverage efficiencies in the delivery of care to enrollees, and possibly their quality ratings and bonus payments.  Decisions made by these firms could have important implications for beneficiaries with respect to their choice of plans, out-of-pocket costs, and access to providers.

Achieving a reasonable balance among multiple goals for the Medicare program including keeping Medicare fiscally strong, setting adequate payments to private plans, and meeting beneficiaries' health care needs will continue to be a critical issue for policymakers in the future.

Medicare Advantage Fact Sheet 

Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments 

An Obama administration announcement about payment rates for Medicare Advantage plans in 2015 has set off a dispute about how large or small the changes really are. 

Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program.

But insurers, who have led a fierce lobbying campaign against payment reductions, say the Medicare Advantage plans would sustain a far deeper cut. That's because the lower payment rates will be combined with new health law fees on health plans, a phase-out of the”star rating” system that helped buffer the reductions for Medicare Advantage plans in prior years and Medicare cuts in the automatic federal spending cuts known as”sequestration.”

One insurance industry official, who asked to be not identified Sunday because his organization was still analyzing the impact of the CMS announcement, estimated that Medicare Advantage plans would see their rates drop by a total 6 percent next year.

CMS said Friday its preliminary estimate is”the combined effect of the Medicare Advantage growth percentage and the fee-for-service growth percentage.”

In a statement, the industry group America's Health Insurance Plans' (AHIP) also noted that a number of factors impact Medicare Advantage payment rates.”The growth rate percentage included in the rate notice is only one factor and does not represent what the total cut will be when other factors are included,” AHIP said.

Despite industry concerns in recent years about cuts in federal funding, the program continues to grow. Enrollment in Medicare Advantage plans rose in 2014 by 8.9 percent to 15.9 million enrollees, up from 14.6 million in 2013, according to a new analysis from consulting firm Avalere Health. Approximately 30 percent of Medicare beneficiaries are enrolled in the plans, which are offered by private insurance companies.

Medicare Advantage Cuts

Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments

Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed

The government provides payments to the insurers for Medicare-covered benefits, such as hospital and physician services, but the plans often offer extra benefits, such as hearing aids or gym memberships, that are not available in traditional Medicare. Most Medicare Advantage plans require that beneficiaries receive care from physicians, hospitals and other providers that contract with those plans. Traditional fee-for-service allows beneficiaries to visit any doctor or provider that accepts Medicare. Insurers and other Medicare Advantage advocates said earlier this month that cuts could cause premium increases and benefit reductions.

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.

Those cuts were strong ammunition for Republicans in the 2010 congressional midterm elections when the GOP recaptured the House and in the 2012 presidential contest. In a recent flurry of letters to the administration, both Democrats and Republicans have expressed concerns about the impending cuts.

Republicans wasted no time Friday criticizing the proposed cuts.”The hard truth is now apparent millions of seniors who rely on the Medicare Advantage program will lose the plans, benefits, doctors and financial protection they currently have,”  said Rep. Dave Camp, R-Mich., chairman of the House Ways and Means Committee. 

Sen. Orrin Hatch, R-Utah, the ranking Republican on the Senate Finance Committee, said the proposed reductions”threaten a successful program for seniors, and must be overturned.  Medicare Advantage is extremely popular for a reason run through the private market, seniors gain access to high-quality and coordinated care with additional benefits that they otherwise wouldn't get.  Regrettably, this administration continues to undermine this critical program.”

But others say the payment changes are needed.”The reductions should continue to go into effect in order to ensure more parity between [Medicare Advantage] plans and traditional Medicare with respect to how much is spent on beneficiaries,” the Center for Medicare Advocacy wrote Thursday. 

“Further, if overall Medicare costs continue to grow more slowly than expected, which is good news for Medicare and the federal budget, [Medicare Advantage] payment should be adjusted accordingly. There is no reason [Medicare Advantage] payment should increase at the same time that overall Medicare costs are slowing,” it added.

The costs of plans and the additional benefits they may offer — vary widely around the country.  Insurers UnitedHealthcare and Humana make up more than 40 percent of Medicare Advantage enrollees.

Last year, Medicare officials initially proposed reducing Medicare Advantage payments by 2.2 percent, but after another strong industry lobbying campaign, the administration switched gears and raised the rate by 3.3 percent, although an AHIP analysis found the combined effect of other factors in the health law combined to produce a 6 percent rate cut in 2014.

Some analysts predict the Obama administration again will be under intense political pressure to moderate the proposed 2015 payment rates when they are finalized in April. 

Seniors make up a higher percentage of voters in non-presidential election years than in presidential election years, said Paul Heldman, senior health policy analyst for Potomac Research Group, a Washington policy analysis firm for institutional investors. Cuts mean plans may drop out of certain areas or cut certain benefits, which is a political liability for Democrats in tough races.  

The costs of plans and the additional benefits they may offer — vary widely around the country. Insurers UnitedHealthcare and Humana make up more than 40 percent of Medicare Advantage enrollees.  

AHIP has already begun a grassroots lobbying effort that includes television and print advertisements with seniors reminding members of Congress that they are a potent voting bloc. The group also funded a study that shows the cumulative effect of the expected cuts, coupled with other federal spending reductions,  means that beneficiaries could face premium increases and benefit reductions of $35 to $75 per month, or $420 to $900 if Medicare Advantage payments are reduced by 6 percent in 2015.

Some analysts say it makes no sense to cut payments to a popular program.”Our concern is that if the program is not sustainably funded, it may not be able to keep up with a demand that is only going to increase,” wrote Douglas Holtz-Eakin and Kenneth Thorpe, co-chairs of the Partnership for the Future of Medicare, a bipartisan group that advocates for programs to make Medicare secure. 

In their Feb. 11 letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner, Eakin and Thorpe  also wrote”our fear is that additional cuts to the [Medicare Advantage] program in 2015 could mean that millions of [Medicare Advantage] beneficiaries will lose access to their preferred health plans and doctors and drive more beneficiaries into the flawed fee-for-service system.”

Holtz-Eakin is a former director of the Congressional Budget Office who now heads the American Action Forum, a right-leaning think tank.  Thorpe is chairman of the Partnership to Fight Chronic Disease and chairs the Department of Health Policy & Management at Emory University.  During the Clinton administration, Thorpe was deputy assistant secretary for health policy at the Department of Health and Human Services.

Final Medicare Advantage payment rates for 2015 are scheduled to be released April 7.

Obama Administration Proposes 1.9% Cut In Medicare Advantage Payments 

Secretive Reviews Target 30 Medicare Advantage Plans

Secretive Reviews Target 30 Medicare Advantage Plans

Fred Schulte, Center for Public Integrity Monday, 9 Jun 2014 | 10:33 AM ET NBC News SHARES

This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.

After years of criticism that they cost taxpayers too much, private Medicare Advantage health plans are facing landmark audits that for the first time could order them to repay the government tens of millions of dollars for past overcharges and other billing mistakes.

Medicare pays the health plans a set amount monthly for each person based on estimates known as”risk scores” of how sick they are. The industry has grown explosively over the past decade under this payment method and now cares for nearly 16 million people at a cost expected to top $150 billion this year.
Getty Images Marilyn Tavenner, Administrator at the Centers for Medicare and Medicaid Services

The government audits are targeting chronic Medicare Advantage billing errors that federal officials blame for billions of dollars in”improper” payments every year mainly due to inflated estimates of the health”risks” of the seniors the plans insure. The findings carry added importance because insurers selling policies on exchanges set up under the Affordable Care Act will be paid under a similar risk-based formula, which officials expect to reduce overall health care expenditures.

HEALTH INSURERS HAVE THEIR WAY WITH REGULATORS

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The secretive audit process is known as Risk Adjustment Data Validation, or”RADV,” in Washington parlance. In early November 2013, federal officials notified 30 health plans that they had been selected for review this year. Officials declined to name the companies or discuss the audit process. So it's not clear if any of these audits have yet been completed, or what the results might be.

The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly conducted some of these RADV (pronounced RAD'-vee) audits since 2008. But the agency has never before imposed stiff financial penalties for overbilling the government, as it now intends to do. In the first round of audits, officials expect to recoup as much as $370 million from overpayments allegedly made to the 30 Medicare Advantage plans during 2011, according to CMS.

However, that figure is well below previous administration estimates, and health plans have been granted extensive appeal rights that could stall any repayment orders for years.

Read the Center for Public Integrity's version of this article

CMS is part of the Department of Health and Human Services (HHS). The HHS Office of Inspector General, which acts as a watchdog over CMS, has done some of its own audits of Medicare Advantage. It estimated much higher losses in six plan audits it conducted starting late in 2008. Those audits found that just the six plans reviewed had been overpaid by as much as $650 million for 2007 alone because of inflated risk scores, including payments for diseases that couldn't be verified through a patient's medical record.

The HHS inspector general audits are more worrisome to the industry than the CMS audits because the findings are made public and often draw media notice and attention from members of Congress. But the inspector general's office has said it won't be conducting any more of its reviews for the foreseeable future due to budget cuts, leaving oversight in the hands of CMS.

Secretive Reviews Target 30 Medicare Advantage Plans

Medicare Advantage: Take Another Look 

While health policy observers are mainly focused on the number of people enrolled in the new federal and state marketplaces, fewer are keeping a close eye on fairly big changes in the estimates and projections for enrollment in Medicare Advantage plans. The number of Medicare beneficiaries in Medicare private plans reached an all-time high this year of nearly 16 million beneficiaries, 6.3 million higher than the Congressional Budget Office (CBO) had projected in 2010 soon after the Affordable Care Act (ACA) was enacted (Figure 1). The CBO now projects Medicare Advantage enrollment will reach 22 million beneficiaries by 2020, more than double the number projected shortly after the ACA was enacted.

Figure 1: Medicare Advantage Enrollment in 2014 Exceeds Projections by 6 Million Beneficiaries

Medicare Advantage enrollment was expected to decrease in response to the reductions in payments to plans that were included in the ACA. The ACA payment reductions were adopted in response to concerns that Medicare was paying 14 percent more for beneficiaries in Medicare Advantage plans than it did for beneficiaries in traditional Medicare, on average.  This contributed to higher Part B premiums for all beneficiaries and to Medicare's fiscal challenges. The ACA froze payments to plans for 2011 and then phased in reductions between 2012 and 2017.  The reductions were implemented by county on a 2-year, 4-year and 6-year schedule, with the longest phase in allowed for counties with relatively larger payment reductions.  The phased-in approach aimed to give insurers more time to adjust to the reductions and to find ways to deliver services at a lower cost without negatively affecting the quality of patient care.

The payment reductions have now been fully implemented in more than half of all counties and will be fully implemented in about another quarter of counties next year (Figure 2). Since 2010, enrollment has increased by more than one third in the counties with a slower, 6-year phase in, and by even more in the other counties. Nationally, Medicare Advantage enrollment has increased by 41 percent since 2010.

Figure 2: Status of Medicare Advantage Payment Reductions as of 2014

When Congress debated the payment reductions in 2010, forecasters and analysts also projected that reductions would drive insurers to raise premiums, cut extra benefits and even pull out of the Medicare Advantage market as they did after the Balanced Budget Act of 1997.   Thus far, however, the response by insurers to the ACA cuts has been more muted.

Beneficiaries today are able to choose among 18 Medicare Advantage plans, on average a drop from prior years but still a fair amount of choice by most standards.   Some Medicare Advantage plans terminated or consolidated coverage, but others are moving into new counties and expanding coverage, suggesting that at least some insurers are optimistic about their financial prospects.

The steady but unexpected rise in enrollment may be partly attributable to the quality bonus demonstration implemented by the Centers for Medicare and Medicaid Services between 2012 and 2014.  The demonstration awarded bonuses to nearly all Medicare Advantage plans and boosted the size of the bonuses beyond what the ACA provided. The bonuses helped to offset more than one-quarter of the projected Medicare Advantage reductions in plan payments over these three years. Plans were required to use all bonus payments to provide extra benefits to enrollees, attracting more seniors to Medicare Advantage plans.

As Medicare Advantage enrollment increased, monthly premiums actually declined (from an average $44 per month in 2010 to $35 per month in 2014). Still, some evidence indicates that plans have made other adjustments to cut costs, for example, by increasing out-of-pocket limits, which could affect beneficiaries with relatively high health care expenses, and by narrowing their provider networks.

Plans may be looking for ways to tighten their belts and maintain profits, but the changes thus far do not seem to be scaring seniors away. CBO's most recent projections show enrollment on track to increase steadily through 2023.   Looking forward, it will be important for beneficiaries to monitor potential changes in their coverage, costs and provider networks, with the bonus demonstration ending and plans continuing to adjust to lower payments and changing market conditions. But, for now, as Mark Twain might have said, the reports of the demise of the Medicare Advantage program appear to be greatly exaggerated.

Medicare Advantage: Take Another Look 

Feds seek new authority to recoup Medicare Advantage overcharges 

Medicare Advantage Money Grab 30 likes 51 tweets 3 comments E-mail Print 

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Federal officials, facing criticism they overpay Medicare Advantage plans for the elderly by billions of dollars annually, are seeking new power to recover excessive charges.

The Centers for Medicare and Medicaid Services says its wants to set up a formal process to recoup overpayments made to the health plans. The draft regulation is set to be published on July 14 and a final decision on the proposal is due by November 1.

Federal officials have struggled to pay the senior care plans accurately for years. A Center for Public Integrity investigation published last month found that Medicare paid the health plans nearly $70 billion in improper payments mostly inflated fees from overstating the health risks of patients from 2008 through 2013 alone.

Medicare expects to pay more for sicker patients and less for those in good health using a formula known as a risk score. But CMS largely trusts health plans to identify and return any money paid in error.

In its proposal, CMS acknowledges it lacks a process for routinely going after these overpayments even though its own auditors estimate that Medicare loses billions annually as a result.

How much money CMS expects to recover also remains unclear. CMS said the health plans could be on the hook for overpayments dating back six years, but the agency did not indicate that it is ramping up audits to catch health plans that overbill.

CMS said that once it identifies an overpayment, most health plans return the money. Cases in which they don't do so voluntarily happen very infrequently, according to CMS. The agency said health plans would routinely be notified of payment errors and allowed to appeal any repayment orders through an administrative process.

“Deterring improper payments is a top priority for CMS in order to protect beneficiaries and taxpayers,” said CMS spokesman Raymond Thorn.”This new rule is just another tool that CMS would use to recover improper payments in the Medicare program.” 

It's unclear, though, whether CMS will stick to its guns. In the past, the agency has regularly backed off proposed efforts to tighten oversight in the face of industry opposition. The draft regulation was quietly disclosed late last week. According to the rulemaking process, it will be subject to a public comment period before a final decision to issue the rule is made.

Feds seek new authority to recoup Medicare Advantage overcharges 

5 Things to Know About UnitedHealth's Cut of Medicare Advantage Providers

5 Things to Know About UnitedHealth's Cut of Medicare Advantage Providers

Written by Ayla Ellison (Twitter | Google+)  | July 17, 2014

UnitedHealth Group has been eliminating physicians from its provider networks for Medicare Advantage plans across the nation to help control costs, and it is a trend that is set to continue.

Here are five things to know about the cuts:

1. UnitedHealth is the country's largest provider of privately managed Medicare Advantage plans, and the company has cut thousands of providers in its Medicare Advantage networks in states across the country, including Alabama, Connecticut, Florida, Georgia, Massachusetts, Missouri, North Carolina, Rhode Island and Tennessee.

2. In December 2013, UnitedHealth attributed its decision to narrow Medicare Advantage plan provider networks on”an era of Medicare Advantage funding cuts,” according to a report from The Hill. For the entire 2013 fiscal year, UnitedHealth brought in $122.5 billion in revenue, up 10.7 percent from 2012, while earnings rose 1.8 percent to $5.63 billion. However, during the first quarter of 2014 the company's net earnings fell 7.8 percent, from approximately $1.2 billion in 2013 to $1.1 billion this year. UnitedHealth's financial growth was”offset by headwinds from new [PPACA] taxes and Medicare Advantage funding deficiencies,” said Stephen J. Hemsley, president and CEO of UnitedHealth in a news release.

3. In Massachusetts, UnitedHealth plans to cut up to 700 physicians in its Medicare Advantage network, effective Sept.1. The company said it will not be dropping any hospitals from it Massachusetts coverage, as it has controversially done in other states. In Connecticut, UnitedHealth dropped roughly 2,200 physicians from its Medicare Advantage network last fall, which led to two physician groups filing a lawsuit against the insurer.

4. In April, UnitedHealth cut almost 100 physicians from its Medicare Advantage network in Missouri, and in July the insurer announced it will make further cuts in the state beginning in September. UnitedHealth told St. Louis Today that the main factors for the change were the health industry's move toward quality over quantity and a closer collaboration between payers and physicians.

5. In July, legislation that would prevent Medicare Advantage plans from dropping providers in the middle of the year was introduced in Congress. Sens. Sherrod Brown (D-Ohio), Richard Blumenthal (D-Conn.) and Rep. Rosa DeLauro (D-Conn.) introduced the The Medicare Advantage Participant Bill of Rights Act, which would require Medicare Advantage plans to finalize their provider lists 60 days before the annual enrollment period.

Rep. DeLauro announced her intention to introduce the bill in April in response to  UnitedHealth's move to cut thousands of providers from its Medicare Advantage networks at the end of 2013.”The timing and scale of UnitedHealth Group's provider cuts have been extremely disruptive to patient care and put participants at risk,” said Rep. DeLauro, in a news release.”We have a responsibility to ensure Medicare Advantage plans are serving the needs of their participants.” Sen. Blumenthal's decision to introduce the legislation was also partially prompted by UnitedHealthcare.”Our experience with UnitedHealthcare Group unconscionably dropping hundreds of physicians provides powerful evidence for this stronger protection,” said Sen. Blumehthal in a news release.

5 Things to Know About UnitedHealth's Cut of Medicare Advantage Providers

Medicare Advantage Prescription Drug Plans | Medicare.com

About Medicare Advantage (Part C) Frequently Asked Questions Medicare Advantage (Part C) 

Medicare Advantage plans, also called Medicare Part C plans, are available through private insurance companies and must provide at least the same coverage as Original Medicare, Part A and Part B (with the exception of hospice care, which is still provided by Original Medicare).

Some Medicare Advantage plans cover prescription drugs. These plans combine your Medicare health benefits and prescription medications. If you have a Medicare Advantage plan with prescription drug coverage, you don't need a separate Medicare Part D Prescription Drug Plan.

You can join a Medicare Advantage plan that doesn't include prescription drug coverage, but please note that these plans might not let you join a stand-alone Medicare Part D plan. There are some exceptions, but in most of these situations if you want prescription drug coverage, you would either have to:

Disenroll from your Medicare Advantage plan during the Medicare Advantage Disenrollment Period from January 1 to February 14, and go back to Original Medicare Part A and Part B coverage, then add a Medicare Part D plan, or

Join a Medicare Advantage plan with prescription drug coverage during the Annual Election Period (AEP), from October 15 to December 7 of each year.

Eligibility and enrollment

Eligibility requirements are the same for Medical Advantage plans with or without prescription drug coverage.

You must be enrolled in both Medicare Part A and Part B.

You must reside within the service area of the plan.

Beneficiaries with end-stage renal disease (ESRD) are excluded from Medical Advantage plans, there are certain exceptions.

Most Medicare Advantage plans have network guidelines as well, meaning that you must use network providers.  If the plan lets you see providers outside of the network, you may pay more.

You can enroll in a Medicare Advantage plan during any of these opportunities:

Your Medicare Initial Enrollment Period (IEP), which usually begins three months before your month of Medicare eligibility and lasts for seven months.

During the Annual Election Period (AEP) (October 15- December 7 each year).

During a Special Election Period (SEP) that may be available to those who qualify because of a special circumstance or condition.

If you join any type of Medicare Advantage plan, you must continue to pay your Medicare Part B premium.

To browse a list of Medicare Advantage plans nearest you, feel free to use our no-obligation Medicare plan comparison tool. Simply enter your zip code in the box to get started.

Medicare Advantage Prescription Drug Plans | Medicare.com

Do patients choose Medicare Advantage for convenience?

Do patients choose Medicare Advantage for convenience?

David Mokotoff, MD | Policy | July 25, 2014

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Having just retired on July 1st, my medical group's commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap.

I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has been nothing short of an eye-opener. I should have of course known better, embarking on any venture with a government agency. I signed up online for Medicare Part A, but Part B was more challenging since I didn't want to start collecting Social Security at the same time and the computer program didn't like this.

There is of course Medicare Part A, which covers hospital bills, and Medicare Part B that covers other medical and physician service. Then there is Part D that is the drug prescription plan.  Medicare HMO's combine A, B and D for one set fee and are known as Medicare Part C, or Medicare Advantage. However, hospital, physician, and drug choices are severely limited when signing up for Part C, no matter what the insurance company's marketing advertises. Medigap plans can be purchased to fill in the many holes which A and B do not cover, for another premium. This is also called Medicare Part F. Are you still with me?

Now there is also Medicare Parts E, G, H, I, J, K and L. But let's skip those for now. By late spring of this year, my head was spinning. I threw in the towel and used an insurance expert to help me navigate this alphabetical morass. Within the past two months, hardly a day would pass without some document arriving form Medicare, Social Security, or United Healthcare, the private insurance company that I had chosen for my Part D and F plans. Thankfully, they have an almost 24/7 telephone help line. I was told in writing no less than three times that my Medicare Part B would be higher than normal due to my high previous year's income. I was asked in writing to verify, in writing, why I hadn't applied for Medicare Part D benefits from the start of the year.

My epiphany was that many of my former patients probably chose Medicare Part C or HMO plans, not just to save money, but also not to have to deal with this endless maze of paperwork and redundancy. This system is so cumbersome, arbitrary, and difficult to understand that only another government agency, the IRS, can make it look simple.

I have come to the conclusion that navigating all of these arms of the Medicare tendrils is almost a full time job. I have a much better appreciation for what my patients have had to endure all these years while I was simply trying to diagnose and treat their heart disease. It is no wonder our Medicare system is such a mess.

Do patients choose Medicare Advantage for convenience?

Individual Health Insurance Costs up to 60% Less - A State by State Comparison

One of the primary reasons employers are canceling group health insurance in favor of individual health insurance and defined contribution healthcare is that individual health insurance costs less.

The following U.S. maps show a state-by-state cost-comparison of average individual health insurance premiums (offered through the federally-run Individual Health Insurance Marketplace in 2014), compared to average group health insurance premiums.

State by State Cost Comparison – Individual vs. Group Market

In all states using the federally-run Marketplace (healthcare.gov), individual health insurance policies are less expensive than group health insurance  even before one takes into account premium tax credits.

As the maps below show, this holds true across Bronze, Silver, and Gold individual health plans. Bronze Level Plans

In a majority of states, Bronze level individual health premiums cost 40%-60% less than group health premiums.

Silver Level Plans

In a majority of the states, Silver level individual health premiums cost 20%-40% less than group health premiums.

Gold Level Plans

In a majority of the states, Gold level individual health premiums cost 20%-40% less than group health premiums. In no states do Gold level individual health premiums cost more than group health premiums.

Map Source:  The Inevitable End of Small Business Health Insurance Whitepaper. About the Data

Individual Marketplace Rates: Data was derived from CMS data available for the states using the Federal Health Insurance Marketplace. Rates were based on a 40-year old, non-smoker and are averages by state and metallic level. Sources:  QHP Landscape Individual Market Medical and QHP Landscape SHOP Market Medical datasets ( https://data.healthcare.gov/).

Group Health Insurance Rates: Data was derived from the Kaiser Family Foundation. Rates are state averages from 2012, single coverage. Source:  Average Single Premium per Enrolled Employee For Employer-Based Health Insurance ( http://kff.org/other/state-indicator/single-coverage).

Shift to Individual Health Plans and Defined Contribution

Due to the high cost of group health insurance and the better value of  individual health insurance, small businesses have begun shifting employees to the  Individual Market and are replacing existing employer-sponsored health insurance premium  contributions with a Defined Contribution toward employees' individual health insurance  premiums.

Read more about the Shift to Defined Contribution Healthcare.

health insurance costs Individual Health Insurance Premiums Rates health insurance premiums state by state Note: This should not be taken as legal or tax advice.

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Update: Individual Health Insurance Landscape in Minnesota

Update: Individual Health Insurance Landscape in Minnesota

Posted Jun 30, 2014
By Jenifer Dorsey

For Obamacare's first open-enrollment period, Minnesota chose to establish a state-based health insurance exchange. As of now, the state will continue operating its own exchange, MNsure, for 2015.

Despite initial technical difficulties and long waits to get through to MNsure customer service, Minnesota exchange enrollment numbers for 2014 seem strong. Between Sept. 30, 2013 and May 1, 2014, the number of uninsured Minnesotans decreased 40.6 percent (180,500) the lowest rate since the 1990s, when the State of Minnesota began estimating health insurance coverage. 1 In a related press release, an infographic compared this reduction as similar to the population of Salt Lake City, Utah, or enough people to fill 14 football fields full of people lined up side by side.

Latest Minnesota exchange enrollment numbers
As of June 16, 2014, MNsure enrollment numbers were as follows 2 :

Medical Assistance (Minnesota's Medicaid program): 139,948

MinnesotaCare (for those without access to affordable health care): 49,768

Qualified Health Plans: 51,831

Total: 241,547

According to a Nov. 2014 analysis by the Henry J. Kaiser Family Foundation, there were an estimated 298,000 potential Marketplace (e.g., the state-based and federally facilitated exchanges) enrollees for Minnesota in 2014.

Minnesota health insurance carriers on and off the exchange
Carriers participating in MNsure's individual and small group health insurance exchanges include the following:

Blue Cross Blue Shield of Minnesota

HealthPartners

Medica

PreferredOne

UCare Minnesota

Carriers are also selling ACA-compliant health insurance away from the MNsure exchange. These carriers are as follows:

Blue Cross Blue Shield of Minnesota

HealthPartners

Medica

PreferredOne

While all health insurance plans sold on and away from the exchanges are required to adhere to the same ACA provisions, those sold in the private marketplace do not qualify for premium tax credits or cost-sharing subsidies. However, those sold in the private marketplace may have more robust provider networks read Obamacare Exchange Tip: Check the Network Before You Buy a Health Plan or talk to your health insurance carrier or agent to learn more about provider networks when choosing a health insurance plan.

More carriers may join or leave the state-based and federally facilitated health insurance exchanges for 2015. We will learn more as 2015 open enrollment nears (as of now, it begins Nov. 15, 2014).  

What should Minnesotans who missed 2014 open enrollment do?
Open enrollment for 2014 health insurance coverage is now closed. However, those with qualifying life events may be eligible for a special enrollment period. Visit MNsure.org or contact a health insurance agent to determine whether or not you qualify for special enrollment.

Those looking for temporary health insurance coverage until their 2015 health insurance begins can visit healthedeals.com or call 888-839-7679 to talk to a health insurance agent about their options.

Note: Temporary health insurance plans are not ACA-compliant and will not prevent you from owing a tax penalty; however, they do offer benefits to help pay for unexpected medical expenses related to accidents and illnesses.

1 Mnsure. Affordable Care Act, MNsure Cut Minnesota's Uninsured Rate Nearly in Half [Press Release]. June 11, 2014.
2 MNsure. Enrollment Update. June 16, 2014.

Jenifer Dorsey is a freelance writer whose specialties include health and fitness, wellness, sports and recreation. She is a competitive amateur track cyclist who also enjoys mountain biking, hiking, camping and other outdoor adventure. Jenifer received a B.A. in journalism from Columbia College Chicago and is an MFA candidate at Naropa University. She lives in Colorado. see here http://www.gefaelltmirbuttoneinbinden.com Tweet

Update: Individual Health Insurance Landscape in Minnesota

The Importance Of Short Term Health Insurance | ymirproject.eu

Rising medical costs make individual health insurance a necessity. One accident, one serious illness, or one debilitating condition can destroy a lifetime of wealth. Occasionally, individuals may find themselves temporarily without individual health insurance due to graduating from college, changing jobs, or becoming too old to remain on their parents' policy.

The solution is short-term health insurance. These policies allow you to purchase individual health insurance from health insurance companies for periods of 12 to 36 months, 12 months being the norm. By investing in affordable short-term health insurance, you are protecting yourself from potential physical and financial disaster.

The Importance Of Health Insurance

Individual health insurance not only provides you with preventative measures such as immunizations and regular exams, but they also allow you to receive early diagnosis for more serious conditions, which makes treatment far more effective. Studies have shown that uninsured individuals are 30-50% more likely to require medical attention for avoidable conditions than those with independent health insurance.

If you're young and healthy, you may not believe individual health insurance is necessary or worth the money. However, consider that a single emergency room visit averages $3,300. If you don't have that kind of money to throw around, the cost of individual health insurance looks far more affordable.

Short-Term Health Insurance Gets You Through Transitions

Short-term or temporary insurance policies provide you with coverage during transition periods of your life, regardless of your age. Since these policies are underwritten, you generally must be healthy to qualify. Individuals with pre-existing conditions normally cannot get short-term health insurance. Health insurance companies are willing to provide short-term policies only because they do not expect you to file a claim.

Short-term individual health insurance is generally less expensive than other types of insurance. If you lose your access to a job-related policy or your parents' policy, you may be able to extend those policies through COBRA, the Consolidated Omnibus Budget Reconciliation Act, so long as certain conditions are met, but even those policies tend to be more expensive than short-term policies. In addition, you must become knowledgeable about your rights and responsibilities before allowing a policy through COBRA to lapse. A lapsed policy causes you to lose many of your rights. You may be denied coverage for pre-existing conditions and you may be ineligible to purchase an independent health insurance policy later on.

Know What You Are Buying And What You Must Pay

Many healthy individuals are able to receive short-term comprehensive coverage for as little as $100 each month. For some, the premium may be even less. The important things to know before signing onto a policy are what is covered, how much you must pay, and any other restrictions or responsibilities the insurance company requires of you.

Short-term health insurance does not generally cover preventative care. Short-term insurance is useful in cases that require hospitalization, expensive diagnosis, or emergency care. It is important to understand how your deductible works and how much it is. If your deductible is too high, you will be paying for much of your medical care yourself. If your deductible is too low, it will cause your premiums to increase.

Short-term individual health insurance is an inexpensive way you can protect yourself against serious illness or injury during periods of transition in your life. There are specific limitations to coverage, but short-term insurance is far better than no insurance at all. COBRA

The Importance Of Short Term Health Insurance | ymirproject.eu

How to Get Health Insurance for Your Small Business

How to Get  Cheap Health Insurance for Your Small Business

Christina Merhar July 21, 2014 at 3:50 PM   

A common question from small business owners is,”how does our small business get health insurance?” In other words,”how does our small business get health insurance  we can afford?”

That's because even with  new small business health insurance options, small businesses face unique challenges when it comes to getting health insurance – with the number one challenge being cost.

Here's how small businesses can get affordable health insurance, including one cost-effective approach some small business owners haven't thought about before.

Set a Budget

First, what  can  the small business afford for health insurance? Set a monthly or annual budget toward employees' health insurance. 

Tip:  If the small business can afford any contribution, then there is a health insurance solution they can afford. These options are discussed next.

Evaluate Health Insurance Options

Next, understand and evaluate health insurance options. There are two core options for contributing to employees' health insurance:

Offer traditional small business health insurance coverage (a”group health insurance plan”).

Offer a Premium Reimbursement Program (aka healthcare allowances or defined contribution) to reimburse employees for individual health insurance coverage.

To understand how these two options work, it is important to understand the two main types of health insurance: group health insurance and  individual/family health insurance.

Group health insurance  is a type of health policy that is purchased by an employer and is offered to eligible employees of the company, and to eligible dependents of employees. With group health insurance, the employer selects the plan (or plans) to offer to employees. The premium cost is often split between the employer and employee, and there is a minimum percentage rate the employer must contribute. With group health insurance, all employees have the same coverage, network of providers, and carrier.

Individual health insurance plans are policies an individual purchases to cover themselves and/or their family – just like car insurance. Anyone can apply for individual health insurance, and they typically cost 20% – 60% less than group health insurance premiums.  With individual health insurance, employees can customize their coverage, network of providers, and carrier.

As of 2014, insurance companies can no longer decline individuals for individual health insurance based on a pre-existing medical condition. Also as of 2014, there are new premium tax subsidies available to individuals who purchase individual health insurance on the state Health Insurance Marketplaces. 

When small businesses decide on the individual health insurance route, they often offer employees a healthcare allowance to use on individual premiums. This type of offering is called a premium reimbursement program or defined contribution.

Here's a summary of group health insurance vs individual health insurance:

Steps to Get Health Insurance for Your Small Business

Now that you understand the basic options, here are the steps:

Set a budget.

Decide on your approach (group health insurance or individual health insurance with a premium reimbursement program).

Work with a health insurance broker and/or reimbursement software provider to select the right benefits for your business, and receive quotes.

Implement the health benefits, including educating, and onboarding employees.

How to Get Health Insurance for Your Small Business

Kaiser Survey Looks at Individual Health Insurance Enrollees On and Away from Obamacare Exchanges

Kaiser Survey Looks at Individual Health Insurance Enrollees On and Away from Obamacare Exchanges

Posted Jul 16, 2014
By Jenifer Dorsey

While the government has released an enrollment summary with data from the Affordable Care Act's first open-enrollment period and some information on those who purchased health insurance from the new state-based and federally facilitated exchanges, data on non-exchange enrollees has been harder to come by. However, new survey findings from The Henry J. Kaiser Family Foundation provide a more complete picture of those who enrolled in ACA-compliant health insurance for 2014.

The Kaiser Family Foundation's Survey of Non-Group Health Insurance Enrollees, which is the first in a series, may not offer the same data as the government's enrollment summary, but it does offer a look at the views and experiences of those with non-group health insurance coverage since Obamacare's major provisions took effect Jan. 1, 2014.

The survey is, Kaiser claimed in a June 19, 2014, news release, the first look at the national demographic and health profile of people enrolled in ACA-compliant plans, including those who bought coverage outside the marketplace. It also provides insights on those who purchased health insurance plans that were non-ACA compliant.

Who bought individual health insurance in 2014?
Under the Affordable Care Act, as of Jan. 1, 2014, most Americans are required to have health insurance or face a tax penalty. However, in the age of Obamacare, it would seem not everyone is opting in. The Kaiser survey shows the following breakdown of the non-group health insurance market by plan type 1 :

ACA-compliant (net)    68 percent

Exchange 48 percent

Non-exchange 16 percent

Unknown (purchased through broker) 3 percent

Non-ACA-compliant 31 percent

Unknown if ACA-compliant 1 percent

How many 2014 non-group enrollees were previously uninsured?
The Kaiser survey also posed a question not yet answered by state-based and federally facilitated marketplaces: What share of enrollees in ACA-compliant plans were previously uninsured?

The answer: Nearly 6 in 10 exchange plan enrollees were previously uninsured. 2

Kaiser reported that among those who were previously uninsured and enrolled in a Marketplace plan (health insurance sold via the state-based and federally facilitated exchanges) affordability and lack of access to employer-sponsored health insurance were the reasons most commonly cited for not having health insurance. Of this previously uninsured group that enrolled in a Marketplace plan 3 :

71 percent had been uninsured for 2 years or more

45 percent had been uninsured for at least five years

72 percent said they decided to buy health insurance because of the Affordable Care Act

Kaiser noted, These shares are similar when based on all those in ACA-compliant [plans] who were uninsured prior to purchasing their current plan.

In the survey findings, Kaiser also concluded that people in new, ACA-compliant plans are somewhat sicker than those in the non-group market previously, some of whom have been able to retain their non-compliant coverage under transition policies.

The percentage of those non-group enrollees whose self-reported health status was excellent or very good breaks down as follows 4

Exchange-based health insurance plans

Excellent 21 percent

Very good 27 percent

ACA-compliant health insurance plans purchased off-exchange

Excellent 28 percent

Very good 37 percent

Non-compliant health insurance plans

Excellent 28 percent

Very good 37 percent

Are people satisfied with their Obamacare health insurance coverage?
When asked, How would you rate your overall health insurance coverage excellent, good, not so good, or poor? the majority of participants in non-group and employer-sponsored health insurance plans answered excellent or good. Their answers broke among plan type down as follows 5 :

Compliant non-group health insurance plans

Excellent 19 percent

Good 52 percent

Non-compliant non-group health insurance plans

Excellent 31 percent

Good 54 percent

Employer-sponsored health insurance plans

Excellent 38 percent 

Good 47 percent

Kaiser also looked at whether or not surveyed enrollees considered their health insurance a value and compared these responses with those who have employer-sponsored health insurance and were interviewed in a separate May 2014 survey 6.

Compliant non-group health insurance plans

Excellent 21 percent

Good 34 percent

Non-compliant non-group health insurance plans

Excellent 14 percent

Good 44 percent

Employer-sponsored health insurance plans

Excellent 30 percent 

Good 40 percent

The report suggested that those enrolled in employer-sponsored plans may be more satisfied since their employers typically pay a substantial portion of their premiums. People in ACA-compliant non-group plans were most satisfied with their choice of hospitals and primary care doctors and least satisfied with their annual deductible. Among those with ACA-compliant non-group plans who switched health insurance plans were less satisfied with their new health insurance coverage than those who were previously uninsured.

To read more about the survey and read the report, visit kff.org.

Need health insurance?
If you do not have health insurance coverage and do not qualify for a special enrollment period, you may consider temporary health insurance. Temporary health insurance, often called short-term medical insurance, is not ACA-compliant and will not prevent you from owing a tax penalty for going without health insurance; however, it does offer benefits that help pay for medical expenses related to accidents and unexpected illnesses.

To learn more, call 888-839-7679 to speak to a health insurance agent.  You may also visit healthedeals.com to get a temporary health insurance quote and compare plans from multiple carriers, as well as read articles about the Affordable Care Act and how health insurance works.

1 Hamel, Liz, et al. Survey of Non-Group Health Insurance Enrollees. The Henry J. Kaiser Family Foundation. June 19, 2014. Retrieved from.
2 Ibid.
3 Ibid.
4 Ibid.
5 Ibid.
6 Ibid.

Jenifer Dorsey is a freelance writer whose specialties include health and fitness, wellness, sports and recreation. She is a competitive amateur track cyclist who also enjoys mountain biking, hiking, camping and other outdoor adventure. Jenifer received a B.A. in journalism from Columbia College Chicago and is an MFA candidate at Naropa University. She lives in Colorado. see here http://www.gefaelltmirbuttoneinbinden.com Tweet

Kaiser Survey Looks at Individual Health Insurance Enrollees On and Away from Obamacare Exchanges