Medicare Advantage Enrollment Doubles | Squared Away Blog

Medicare Advantage Enrollment Doubles

Enrollment in the Medicare Advantage plans that private insurers offer as an alternative to traditional Medicare coverage has more than doubled over the past decade, the Kaiser Foundation reports.

The share of the Medicare population enrolled in these private plans is 30 percent, up from 13 percent in 2005, the non-profit foundation said.

The reason for this dramatic growth: Medicare Advantage became a better deal for older Americans in the wake of a 2003 increase in federal subsidies to insurance companies offering the plans.

The federal government subsidizes insurers through its reimbursements for the care they cover for older Americans enrolled in Medicare Advantage. Those payments were increased in 2003. Insurers responded by reducing beneficiaries' copayments and cost-sharing in the plans and by providing medical services not always available to people who enroll directly in Medicare and purchase Medigap policies, said Gretchen Jacobson, an associate director of Kaiser's Medicare policy program.

The extra services include gym memberships, eye glasses, dental care, and preventive medical care. To rein in their overall medical costs, Medicare Advantage plans restrict the hospitals and doctors that patients can use.

Another factor fueling rising enrollment is that more insurers moved into rural markets to sell their Medicare Advantage plans after the 2003 funding changes, Jacobson said.

By 2009, increases in federal funding to Medicare Advantage plans had pushed to 14 percent the premium in per-beneficiary funding these plans received in excess of funding for beneficiaries directly enrolled in traditional Medicare. The Affordable Care Act cut that premium back to 6 percent in 2014, and it is projected to fall to 1 percent by 2017.

Nevertheless, the Congressional Budget Office anticipates that Medicare Advantage enrollment will continue to rise, albeit more slowly than in recent years. tags healthcare Previous Post Next Post

Medicare Advantage Enrollment Doubles | Squared Away Blog

Medicare Advantage vs Medigap

Many Medicare beneficiaries don't know that Original Medicare does not cover every medical expense. There are quite a few items that are not covered including prescription drugs which usually come out of pocket. If you are enrolled in Medicare Part A and Part B but want more coverage, than private health insurance is a readily available option. Medigap and Medicare Advantage are both offered by private insurance companies and resolve the coverage gap issue. However, this is where the similarities between the two options stop.

Medicare Advantage

Medicare is made up of four major components. Part A and Part B are included in Original Medicare while Part C or Medicare Advantage and Drug Coverage or Part D makeup the rest of the plans. Medicare Advantage is an option for beneficiaries who would like to get their coverage through a private insurance company instead of Medicare. The way Part C works is that people enrolled in the program get their Hospital Insurance and Medical insurance from a private company that is under contract with the federal government. Members receive the same Part A and Part B benefits which are paid for by the government through a flat fee to private insurers.

Medicare Advantage usually goes beyond the coverage of Part A and Part B and in many cases has prescription drug insurance. These features also mean that a beneficiary ends up paying higher costs out of pocket then Original Medicare enrollees. Other major differences are related to how the services are delivered to a member. With Standard Medicare, a beneficiary can go to any doctor or care provider that accepts Medicare patients. However, with a private insurance company's Medicare Advantage Plan, an enrollee might have to go to doctors that are in the carrier's network.

Medigap

This coverage plan is called a Medical Supplement and does not replace the Part A and Part B coverage like Medicare Advantage. Instead, Medigap is provided by a private insurance provider to cover the gap left by Original Medicare. That means a beneficiary gets their Part A and Part B through the federal government and any coverage they need beyond this is taken care of by the Medigap policy. Some plans even cover the deductible and copayments associated with Original Medicare, while some plans can also offer health coverage during an emergency if the policy holder is traveling outside of the United States.

Medigap has 10 different standardized plan options that are indicated by alphabetic letters. Massachusetts, Minnesota, and Wisconsin have their own plan, which means only residents of the remaining 47 states have the ability to select from any of the 10 plans. The benefits are the same for the plans and are not affected by the private insurance provider.  However, your premium is calculated using your chosen plan, location, age and other elements.

Choosing the Right Medicare Advantage or Medigap Plan

You cannot use a Medigap plan with a Medicare Advantage plan. This means that you cannot help pay for the deductibles and co-payments and for a Part C plan through a Medigap plan. That is why beneficiaries should choose the plan that best fits their needs. If you find yourself confused by the options, get in touch with a licensed agent from e-TeleQuote on our listed Toll Free Number to get a no obligation quote.

Medicare Advantage vs Medigap

Compare Medicare Supplement Insurance 

 

Compare Medicare Supplements to Medicare Advantage Plans

If you are currently enrolled or soon to be enrolled in Medicare Parts A and B, you usually have two choices as to the best way to supplement your government provided benefits.

Original Medicare A and B have several benefit gaps and will not cover all out of pocket expenses now or in the future.

You could choose to go without any supplemental insurance, but the out of pocket risks associated with this decision are substantial.  For the sake of this article, we'll say that you are deciding between an Advantage plan and Medicare supplement coverage.

Compare Medicare Part C Coverage Options

Not to be confused with Plan C (which is an actual Medicare supplement) Part C is one of the four parts of Medicare and is the generic term that includes all privately sold Advantage plans available for purchase.  (The 4th piece of the puzzle is Medicare Part D and refers to stand-alone prescription drug plans.)

Part C includes only Advantage plans and they are private insurance programs usually purchased from providers like Aetna, Anthem BCBS,  AARP United Healthcare and Humana among many others.  Several companies offer both traditional supplements and Advantage plans direct to consumer through independent agents like us.

Thus, when you compare Medicare supplements to Medicare Advantage (MA) plans, you are simply comparing Part C coverage to Medicare supplements and trying to determine a suitable and affordable way to cover the insurance gaps not covered by Medicare.  It is important to note that you cannot be enrolled in both an Advantage plan and a Medicare supplement at the same time.  It is either one or the other.

Compare Medicare Supplements to Medicare Advantage Plans

Benefits Medicare Supplement Medicare Advantage Plans

Monthly Premiums

Usually higher Especially for plans C, D, F & G

Usually lower than most Medicare supplements

Potential For Out-Of-Pocket Expenses

Less Plans C, D, F, G, N and others offer more comprehensive coverage with less out of pocket exposure

Greater Especially for prolonged illness or serious accident/injury; deductible, copays and coinsurance can add up over time

Yearly Deductibles?

Less Most plans cover all Medicare deductibles (Plan F) but deductibles are small

Yes Varies from plan to plan; inquire about maximum out-of-pocket expenses

Choice Of Doctors & Hospitals

Yes Insured can use any doctor or hospital accepting Medicare

No Insured must stay In-Network to realize most savings from the insurance

Includes Part D Rx Coverage

No Part D coverage must be purchased separately

Yes Some Advantage plans include part D rx coverage, but not all

Overall Flexibility

Yes  Allows insured to change plans and disenroll anytime; no network limitations

No - Insured must wait until certain times of the year to disenroll; can be difficult to re-enroll in a Medicare supplement

Comparing Medicare Rates, Out-Of-Pocket and Flexibility

It is difficult to balance monthly insurance premiums versus potential out of pocket expenses between the two. If you remain in good health, an Advantage plan will be the less expensive choice over time.  However, if you have regular health issues or a significant incident, an Advantage plan can have much higher out-of-pocket expenses.

Furthermore, you simply may not be able to switch back to a traditional supplement if you have certain preexisting conditions.  Most Medicare supplement providers require medical underwriting if you have been enrolled in an Advantage plan for over one or two years.  In other words, you can be declined coverage.  Additionally, it can be difficult to disenroll from a MA plan if it is not the correct time of year.

In fairness, there are states like Florida where Medigap rates are higher than most other places due primarily to the demographics.  And regardless of out-of-pocket expenses, some consumers simply cannot afford both a supplement and a Part D plan.  For these folks, an Advantage plan can be the most suitable option.

Medicare Advantage Networks Doctors and Hospitals

One important difference between supplements and MA coverage are the network options.  Unlike almost all supplements, MA plans have a network of doctors, hospitals and medical facilities that the insured is mostly required to use for service.

The problem arises when a specialist is needed for consult or if the insured is admitted to a rehabilitation or other medical facility that is out of the provider network.  It's not that the insured cannot see these professionals or use the facility, but the Advantage plan may provide little in the way of reimbursement if any at all.  This can lead to significant out-of-pocket expenses.

Prescription Drug Part D Rx Coverage

This is an area where MA plans tend to be more beneficial to the insured.  Current laws allow insurance companies to package Advantage plans and Part D coverage together in one package.  Not all MA plans combine Parts C and D together, but many do as an incentive to the consumer.

Conversely, Medicare supplements and prescription Part D coverage must be sold separately by law.  There was a time when the two plans could be purchased in tandem, but recent regulations separated the two.  Many companies offer both supplemental and Part D, however they cannot be purchased together.

This means that Part D plans will come at an additional cost for those who want a traditional Medicare supplement.  Part D rates vary widely and most consumers purchase coverage based on their current prescriptions.  Typical rates can range from $12 to $100 per month and in most cases suitable coverage can be found for around $25 monthly for the majority of consumers.

What Does The Future Hold For Advantage Plans?

It's hard to say.  Health care reform is an evolving piece of some of the most significant legislation passed in recent decades.  Medicare supplements are here to stay, but Advantage plans might go the way of the dinosaur extinct.

In some states, this is happening already.  In Tennessee, for example, Anthem Blue Cross Blue Shield discontinued all MA plans as of January 1, 2011.  This caught members by surprise and several were scrambling to find replacement coverage.

It is important to note that if your MA provider leaves your service area or discontinues coverage, you will receive an open enrollment window where you can purchase some supplements (or new MA plan if one exists) without any required medical underwriting.

Contact Us For Quotes And Coverage

In summary, there is not a one-size-fits-all plan for Medicare beneficiaries.  You can only base your decision to purchase Part C coverage on what you can best afford now and in the future while also factoring in potential out of pocket expenses.

Compare Medicare Supplement Insurance 

5 Things You Should Know About Medicare Supplement

5 Things You Should Know About Medicare Supplement Plans

Medicare Supplement plans, also known as Medigap policies, can cover some of the costs that Original Medicare coverage does not include. 

The government provides Original Medicare coverage, Part A medical and Part B hospital benefits, to all eligible individuals. However, this coverage is not all-inclusive. Anyone enrolled in the Medicare program will need to decide at some point whether the traditional coverage provided by the government is sufficient for their health needs.

For many, this coverage is not enough, and that's where private insurance plans, like Medicare Supplement plans, come in. These plans can offer coverage for health care costs not covered by Part A and Part B. To join a Medicare Supplement plan, a beneficiary must be enrolled in both Part A and Part B coverage, live in state where the plan is offered, and generally be above the age of 65.

Important facts about Medicare Supplement plans

Before deciding to add this type of insurance plan to supplement Original Medicare benefits, here are five things you should know about Medicare Supplement plans:

1. There are 10 standardized plans in 47 states, with the exception of Massachusetts, Minnesota, and Wisconsin.

In most states, there are 10 standardized types of Medicare Supplement plans labeled A through N. Each standardized plan must offer the same basic benefits, no matter which insurance company is offering it or where it is available. The only thing that will vary between plans of the same letter would be price given that these plans are offering by different insurance companies. Please note that Plan E, H, I, and J are no longer offered; however, these plans have been grandfathered, meaning that anyone who was previously enrolled can keep their plan.

On the other hand, Massachusetts, Minnesota, and Wisconsin do not have standardized plans. Instead, each state has its own unique Medicare Supplement plan offerings.

2. Standardized Medigap policies are guaranteed renewable.

Since 1990, Medicare Supplement plans have been guaranteed renewable, even if you have health conditions. This means that as long as you pay your monthly premium and the insurance company does not go bankrupt, you cannot be dropped from your plan.

3. The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period.

Your Medigap Open Enrollment Period lasts from six months and begins the first day of the month in which you are both age 65 or older and enrolled in Part B. During this time, you have guaranteed issue rights to purchase any Medicare Supplement plan available in your area. This means that insurance companies cannot use medical underwriting to use your health problems to deny enrollment, charge more for coverage, or make you wait for coverage to begin, except in the case certain pre-existing conditions. Please note that some states may have additional open enrollment periods for individuals under the age of 65.

4. Insurance companies charge a monthly premium, which can be set differently depending on the Medigap policy.

As stated before, standardized plans of the same type may still have different costs depending on which insurance company is offering the plan. Each insurance company can decide how much it wants to charge per month through one of three different pricing models. The way a price is set will determine how much you pay for coverage now and in the future, outside of inflation and other factors. Medicare Supplement premiums can be determined in three ways:

Community-rated : Also known as no-age-rated pricing, this pricing model charges the same premium to anyone who is enrolled in the plan, regardless of age. Plan premiums will not change based on age.

Issue-age-rated : Also known as entry age-rated pricing, this model prices the premium based on the age you are when you buy the plan. This plan will not change as you age.

Attained-age-rated : Premiums for these plans depend on your current age, which means that costs would increase with age. While these plans may be cheapest when you are younger, they may become the most expensive type of plan as you get older.

5. Medicare Supplement plans work with Medicare Part D plans, but not Medicare Advantage plans.

As of January 1, 2006, Medicare Supplement plans no longer offer prescription drug coverage. Thus, beneficiaries who need this coverage will need to enroll in a separate stand-alone Medicare Part D plan, also known as a Medicare Prescription Drug Plan.

On the other hand, Medigap policies do not work with Medicare Advantage (Part C) plans. These policies cannot be used to pay any deductibles, copayments, coinsurance, or premiums associated with Part C coverage. Beneficiaries who are enrolled in a Medigap policy may want to drop it if they choose to enroll in a Part C plan; however, if you drop your Medigap policy, keep in mind that you may not be able to get it back.

Before enrolling in a Medicare Supplement plan, remember to compare all available plans in your area to find the right one for you.

Medicare has neither reviewed nor endorsed this information.

5 Things You Should Know About Medicare Supplement

Part D for Disaster | Morning Consult

Part D for Disaster

By Meghan McCarthy

 

Spring officially ended last week, bringing to a close the season of open enrollment on the Affordable Care Act's health insurance exchanges.

It also marked the end of what might have been the administration's greatest unforced political error of 2014 when it comes to health policy. No, it's not those Obamacare insurance exchanges, which ended on a high note with 8 million plus enrollees. It's Medicare Part D.

In addition to getting the insurance exchanges off technological life support and hitting the airwaves to encourage millions to sign up, the administration had to fight two other major health battles this spring, both over Medicare.

One was arguably a game of political cat and mouse over Medicare Advantage, with the administration proposing steep cuts in order to make the final adjustment seem not quite so bad.

But the other was over significant changes to Medicare's prescription drug program. And with it came a lesson on how putting policy before politics in healthcare, particularly ahead of a tough midterm election and without the support of your usual allies on Capitol Hill, can be dangerous.

Late last month the administration gave in on all of its controversial Medicare Part D proposals, arguably putting at risk changes to the popular prescription drug plan for seniors that they had been working towards for the entire Obama administration.

When the administration released the Medicare Part D rule in January, it took some time before the myriad constituencies with interests in the program grasped exactly what the rule did. The proposal was 157 pages long and included major changes to an already complex program that has insurance companies bid through the federal government to offer seniors prescription drug plans.

The most controversial changes included limiting the number of plans that an insurer could offer in a region down to two. Seniors had a choice of at least 23 plans in every region, according to the Congressional Budget Office in 2013. The administration had already moved towards this goal, requiring that plans had meaningful differences from one another. Their argument was that this change would simplify things for enrollees who didn't always pick plans with the best value and prevent insurers from putting sicker, poorer seniors into basic plans.

It also opened up the preferred pharmacy network to any pharmacy that wanted to participate and expanded a medication therapy management program. Finally, what arguably sunk the rule because it garnered the ire of Democrats, it would end rules that required insurers to cover all antidepressant and immunosuppressant drugs. Those were two protected classes of drugs that were established early on in the program, in an effort to prevent plans from keeping sicker patients out of plans by simply not covering the drugs they need.

In any other year, these wonky yet significant changes may have been argued about in the backrooms of Washington. But thanks to the midterm elections, they hit the campaign trail.

The whole rule torpedoed Medicare Part D, Mark Merritt, CEO of the Pharmaceutical Care Management Association, said in an interview. The trade group represents pharmacy benefit managers, which vehemently opposed many of the changes.

We had to start early on with the fact that this is a major campaign issue, as open enrollment is October, for Medicare prescription drug plans, Merritt said. That was when seniors might find out they'd have to go on a different drug plan, conjuring memories of the uproar that was created when insurers canceled individual plans when the ACA's insurance exchanges launched.

This couldn't fester as boring regulatory issue no one cares about, Merritt said. Members of Congress don't usually support things that aren't for their political health What wasn't going to work was bilateral green eyeshade discussion between our coalition and CMS.

PCMA and other groups that opposed the rule did political polling on the proposals. The potential changes became ammunition for Republicans, particularly after the rocky rollout of Obamacare's insurance exchanges. That alone would have been a major obstacle for the administration to clear to get this rule final, but it was the swift pushback from Democrats on Capitol Hill that was likely the nail in the rule's coffin.

The change that had little Democratic support on Capitol Hill was removing the protected classes of drugs. While Republicans argued that changes would introduce too much government regulation into the free market of Part D plans, the pieces that Democrats didn't like would loosen requirements on what drugs had to be covered by plans in an effort to reduce costs. That garnered strong opposition from patient advocacy groups and some of the administration's typically strongest allies.

There are other places where I would like to see the agency rethink its approach. In particular, the six protected classes policy, Energy and Commerce ranking member Henry Waxman (D-Calif.) told CMS' Jonathan Blum at a hearing at the end of February. Rep. Frank Pallone (D-N.J.), the top Democrat on the committee's health subcommittee, echoed those concerns.

Two days later, Sen. Ron Wyden (D-Ore.), who had officially been in the top spot of the Senate Finance Committee for just over a week and was heavily focused on negotiating a bipartisan, permanent fix to the Medicare sustainable growth rate, sent a bipartisan letter from members of the Finance committee urging CMS to start over completely.

Many of the proposed changes are untested and unstudied and could result in significant loss of beneficiary choice, access, and consumer protections, the letter said. We urge you to begin a new dialogue with Congress, Medicare beneficiaries, and relevant stakeholders on how best to achieve the universal goal of a sustainable and successful Part D program.

A little over one week later, CMS Administrator Marilyn Tavenner raised the white flag, sending a letter to Congress that said the agency would not finalize the most controversial proposals.

The final rule came out late last month, and CMS was true to its word, dropping every controversial provision they had initially proposed.

The most instructive part of whole communication was Table 3, where they had the whole list of things that they did not make a decision on, said Debra Devereaux, a pharamceuticals analyst at Gorman Health Group.

It is unclear if the Obama administration will go back and reconsider those rules in the near future, and staff is turning over significantly. Blum announced he would step down from his position in the coming months, and Sylvia Burwell is nearing confirmation to lead Health and Human Services. She has promised Capitol Hill that if the administration considers those proposals again, they will go through regular order. Perhaps next time around, the politics will be different. Share This Article

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Part D for Disaster | Morning Consult

More Hispanics Took Heart Meds After Medicare Part D Launch

More Hispanics Took Heart Meds After Medicare Part D Launch

June 2, 2014

MONDAY, June 2, 2014 (HealthDay News) Hispanics became much more likely to take their heart medicines after Medicare's prescription drug benefit plan was launched in 2006. But there was only a small increase seen among black patients, a new study finds.

Researchers analyzed U.S. government data to identify trends in the four years after the drug plan formally called Medicare Part D was introduced. Patients in all racial groups were more likely to take their prescribed heart medicines, with increases of 60 percent among Hispanics, 47 percent among whites, and 9 percent among blacks.

This resulted in a more than 15 percent decrease in the heart drug adherence gap between Hispanics and whites. However, the gap between blacks and whites increased by more than 5 percent, according to the study, which was to be presented Monday at an American Heart Association (AHA) meeting in Baltimore.

Medication adherence is important because patients with chronic conditions such as high blood pressure or diabetes who often don't stick with their medicines are at greater risk for problems including heart attack, stroke and heart failure, study author Mustafa Hussein, a pre-doctoral fellow in health outcomes and policy research at the University of Tennessee Health Science Center in Memphis, Tenn., said in an AHA news release.

We suspect that medication adherence disparities play a significant role in minority patients' rapid development of high blood pressure and heart disease, Hussein added.

The differences in heart drug adherence between blacks and Hispanics may be due to a number of reasons, the researchers noted. Hispanics may have been more aware of the drug benefit's launch due to their prior use of drug discount card programs, and are more likely to use the Part D low-income subsidy and to be enrolled in Medicare Advantage plans, which offer their own drug coverage.

Health care providers should collaborate in creative ways to empower minorities to overcome issues that can interfere with their health care and medication adherence, such as stress, depression, financial problems and lack of family or social support, Hussein said.

We really need to think more about social disadvantage as the big picture that contributes to all the disparities to health outcomes, not just adherence, he concluded.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More Hispanics Took Heart Meds After Medicare Part D Launch

Antidepressants, Antipsychotics to Remain 'Protected' Medicare Part D Drugs

Bowing to pressure from the AAFP and other stakeholder groups, CMS recently announced a final rule (www.federalregister.gov) regarding the Medicare Part D prescription program that leaves out a controversial proposal that would have removed two drug classes from a protected list of covered medications.

When the rule was first proposed in January 2014, the plan to drop the two drug classes drew heavy criticism from medical organizations and the media. In fact, CMS received more than 7,500 comments on the proposed rule.

Based on the comments received, we have concluded that our proposed criteria did not strike the balance among beneficiary access, quality assurance, cost-containment, and patient welfare that we were striving to achieve, CMS stated in the final rule. We are not finalizing our proposal to establish new criteria for the categories and classes of clinical concern.

The agency further noted, however, that although it has not modified the protected drug classes at this time, it might revisit the issue in the future.

The AAFP had objected to the proposed changes to Medicare Part D prescription drug formularies in a February 2014 letter to CMS. The letter noted that primary care physicians make the majority of depression diagnoses and prescribe more than half of all antidepressants for patients.

The Academy said that restricting access to these medications could increase health costs in other areas, such as by provoking longer hospital stays among acute-care patients and more ER visits by Medicaid patients.

Other sections of the rule were maintained as initially proposed, however, including a requirement that physicians who prescribe Medicare Part D drugs enroll in Medicare or have a valid reason for opting out of the program.

The AAFP had opposed this proposal, arguing that physicians' prescriptive authority is already regulated by the DEA and that such a requirement could deny a patient access to needed medication simply because the physician is not enrolled in Medicare. But CMS stuck to its guns, noting that the requirement is intended to protect against potential fraud by ensuring that only qualified physicians are writing prescriptions.

It's worth noting that although the rule requires physicians who wish to prescribe these drugs to enroll in Medicare by June 2015, it does not require them to participate in Medicare.

Additional information on Medicare contractual options for physicians can be found on the AAFP website.

Finally, CMS will have new authority under the final rule to revoke a physician's enrollment in Medicare if the physician has a history of abusive or improper prescription practices or has his/her license suspended or revoked by the DEA or by the licensing body in the state in which the physician is licensed. In its February letter, the AAFP largely supported this proposal, finding it, in general, to be”reasonable.”

Antidepressants, Antipsychotics to Remain 'Protected' Medicare Part D Drugs