All posts by Angela Scott

Bush Wealth Management: Learn how Medigap choices are changing – Valdosta Daily Times

Plan F is fading away, and Plan G may become the most selected option.      

Soon, the most popular Medigap policy will no longer be sold

Seniors will lose the chance to buy Plan F in 2020 as well as the less popular Plan C. These policies cover Medicare’s Part B deductible, which is currently $183. A new federal law prevents the sale of any Medigap policies that cover this deductible once the 2020s begin.

Be assured, if you already have Plan F (or Plan C) coverage, you can stick with it after 2020. You just cannot buy a new Plan F (or C) policy after that date.

What does this mean if you are considering a Plan F policy? 

The short answer is that if you want to buy Plan F coverage, you have until the end of 2019 to do so. That said, you could be better off with Plan G in the next decade, barring a big jump in Medigap premiums.

Why do people like Plan F? 

It is basically a “Cadillac plan”: it lets you see any doctor or hospital that accepts Medicare patients, and the upfront cost is the total cost. With Plan F, you are not surprised by subsequent requests to pay a deductible, a copayment, or coinsurance.

How does Plan G differ from Plan F? 

While both plans provide similar coverage, the major differences are about dollars and cents. Plan G asks you for the $183 Part B deductible; Plan F does not. Premiums also differ notably. 

Coming into the fourth quarter of 2018, monthly payments on a Plan F policy averaged $185.96. Average monthly premiums on a Plan G policy? Just $155.70.

Plan G appears to be gaining popularity. CSG Actuarial, a firm that provides data to insurance companies, reports that 37 percent of new Medigap enrollees are choosing Plan G (although 53 percent still choose Plan F).

What will happen to Plan F and Plan G premiums in the 2020s is hard to say. 

Plan F premiums may jump because the supply of 65-year-olds buying Plan F will be abruptly cut, leaving an older and less healthy population to cover. 

Plan G premiums could rise also because a Medigap plan must accept new enrollees by the terms of Medicare regardless of how healthy or ill they may be. The current $183 Plan G deductible might significantly increase as well.

Do you think you might switch out of one Medigap policy to another? 

That move may be harder to make once 2020 rolls around. If it has been more than six months since you enrolled in Medicare Part B and you want to switch Medigap plans or supplement traditional Medicare with one, some Medigap insurers in certain states may exercise their right to charge you more in view of pre-existing health conditions and even turn you down. 

It is possible that states may intervene and pass new regulations to prevent this in the coming years.

Securities and advisory services offered through LPL Financial, a Registered Investment Advisor, member FINRA/SIPC. The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. Bush Wealth Management and LPL Financial are separate entities.

Kent Patrick is with Bush Wealth Management.

Jason Smith is a reporter at The Valdosta Daily Times. He can be contacted at 229-244-3400 ext.1257.

Go to Source

Today Ends the Medicare Annual Enrollment Period; Does it Begin a New Private Era for Medicare?

Print Friendly

As reported widely, including in The New York Times,[1] the Trump Administration spent this Medicare Annual Enrollment Period steering beneficiaries towards private Medicare Advantage (MA) plans. While CMS contests this conclusion, Administrator Verma stated they are “unleashing and strengthening” Medicare Advantage[2] and HHS Secretary Azar says he sees Medicare Advantage as the future of Medicare: “There’s a day when we’ll have a majority in MA, and it will be the dominant part of the Medicare system.” [3] This is not good news for beneficiaries or Medicare.

Enrollment in a private MA plan, rather than traditional Medicare, is often a disadvantage for people when they get sick or injured and really need coverage and care. They then find their health care options limited by plan networks, prior authorization requirements and restrictive interpretations of coverage rules.[4] While CMS insists competition results in MA plans providing better coverage, a recent article in the New England Journal of Medicine[5] by researchers at the Kaiser Family Foundation, reports that only 10% of beneficiaries switch plans from year-to-year. What the MA plans know is that initial enrollment is the key; market share is what matters. After people enroll in a plan, perhaps based on assertive marketing, they rarely exit, even if coverage doesn’t meet their needs.

Just as importantly, the increasing bias towards Medicare Advantage is fragmenting and privatizing the Medicare program. With little attention, Medicare is changing into a set of private plans, with traditional Medicare as a public option. At the same time, there is increasing talk of using Medicare as the foundation for universal health coverage. Attention must be paid, and action taken, to slow down the privatization train before it’s too late, and before Medicare becomes the basis for universal coverage.

December 7, 2018 – J. Stein

 


[1]The New York Times, Trump Administration Peppers Inboxes With Plugs for Private Medicare Plans, 12/2/2018. https://www.nytimes.com/2018/12/01/us/politics/trump-medicare-advantage-plans.html  
[2] CMS Fact Sheet: 2019 Medicare Advantage and Part D Rate Announcement and Call Letter, https://www.cms.gov/newsroom/fact-sheets/2019-medicare-advantage-and-part-d-rate-announcement-and-call-letter

[3] Modern Healthcare, “Azar: Drive for site-neutral payment system will continue,” Susannah Luthi, December 4, 2018. https://www.modernhealthcare.com/article/20181204/NEWS/181209982
[4]Mcknight’s,  Researchers Worry Medicare Advantage May be Exerting Wrong Influence on SNFs, 12/4/2018; NY Times, Medicare Advantage Plans Found to Improperly Deny Many Claims, 10/13/2018;  US OIG Report, Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials, 9/28/2018. https://www.mcknights.com/news/researchers-worry-medicare-advantage-may-be-exerting-wrong-influence-on-snfs/
[5] New England Journal of Medicine, Medicare Advantage Checkup, 11/25/2018. https://www.nejm.org/doi/full/10.1056/NEJMhpr1804089

Go to Source

Medigap Deadline Coming Soon – Dailyfly

Dec 31st | Idaho | Under 65 Years Old

LEWISTON, ID – The window for Medigap plans is closing soon for people under the age of 65.  If you’re on Medicare and under the age of 65, the deadline to add an optional Medigap Plan ends on December 31st.

Medigap plans cover much of the area between personal cost and what Medicare covers.

This deadline does not affect people over the age of 65.

The Idaho Department of Insurance created this separate window of opportunity after finding that some Medicare users were unaware of the open enrollment period that ended June 30th.

If you have questions, you can call the Senior Health Insurance Benefits Advisors at the Iaho Department of Insurance at 1-800-247-4422.

137

 

Go to Source

What Are Medigap Plans? – The Yucatan Times

If you are above the age of sixty-five, it means you are now eligible for a Medigap Plan. Medigap is also
known as a Medicare Supplements Plan.

A Medigap is an insurance health claim given by a private insurance company to pay medical costs that
are not covered by the original Insurance. Some health costs covered by Medigap are copayments,
deductibles, and coinsurance. However, Medigap does not cover long term health costs such as dental
surgery, vision care, hearing aids, and private duty nursing. Moreover, they do not cover health costs for
individuals who travel outside the US. You can read about Medigap here.

All About Medigap Plans

There are 10 standard Medigap plans, like the Medigap Plan G. They are labelled alphabetically, from A
to N. These plans are offered according to different levels of care. The same Medigap Plans are offered
in all US states. However, in Massachusetts, Wisconsin, and Minnesota, the Plans are standardized
differently.

It is good to note that, although the Plans are the same, they are offered by different private insurance
companies at different prices.

However, there are two plans necessary for an application to a Medigap. These are Medicare Parts A
and B. These plans are part of the Original Medicare Insurance.
Medicare Part A (Hospital) covers any Medicare received at a hospital, a skilled nursing facility, hospice
care, or at home. One is eligible for Part A if:

● You are over sixty-five
● You have worked for 49 quarters (automatic enrollment in Medicare Part A)
● If you are disabled and live with disability benefits
● You are retired and receiving retirement benefits
● You are suffering from certain diseases, such as end-stage renal disease(ESRD)and amyotrophic
lateral sclerosis (ALS)

Moreover, if you have lived in the US for more than five years, you are definitely eligible for Medicare
Part A.

The enrollment for Medicare Plan A usually begins on January 1st and ends on March 31st. You will
receive your Medicare card three months before the coverage begins.
Medicare Part A coverage

There are a lot of benefits in Medicare part A Insurance. It will cover things critical for your health. This
includes services that are part of your inpatient treatment. Some of them include medications, nursing
services, and meals. However, it does not cover private room services, unless they are medically
necessary.
There are services and supplies offered by the Medicare part A insurance, such as:

Mental health care
● Long terms care services
● Participation in a clinical research study
● Inpatient rehabilitation services
● Critical access to hospitals

Medicare Part B

Medicare Part B is also part of the Original medical coverage. It is used to cover medical supplies and
services necessary for treating your health condition.
If you have enrolled for Medicare Part A, then you are automatically eligible for Medicare Part B. This
means that the same requirements for Part A are needed for Part B.

Medicare Part B coverage.
Medicare Part B usually covers:

Outpatient services
● Preventive services, such as the flu, hepatitis shots, cardiovascular screenings, cancer and
diabetes screenings
● Ambulance services
● Medical equipment

When to enrol for Medicare Part B
Medicare Part B is not necessary. About 10% of beneficiaries of Medicare opt not to take Medicare part
B. It usually comes in a monthly premium.
It is good to note that, if you delay enrolling in Part B, then your premium will rise. This will especially
occur when you were eligible for Part B, and did not sign up. Then your premium could be 10% higher
for a 12 month period.

Part B premium is usually deducted from year to year, and, depending on the amount you have enrolled
for. However, if you receive Social Security benefits, it will be deducted automatically. But, if you do not,
then you will be sent a bill every three months.

Plans C, D, F, G, K, L, and N are used to pay for nursing facility care. On the other hand, only C, D, F, G,
and M are ones that are able help pay for medical emergencies outside the US. In addition, if there is an
excess of payments in Plans F and G, they can be rolled over to Medigap Plan B.

Plan F covers the most comprehensive array of benefits, though it is the most expensive Plan. The prices
are standardized according to the carrier. On the other hand, Plan C covers what Plan F covers, but
minus the charges.

TYT Newsroom

Comments

comments

Go to Source

Use caution when ditching your Advantage Plan for original Medicare – CNBC

If you’re thinking about dropping your Advantage Plan during open enrollment and instead relying on original Medicare, proceed with caution.

When you first enroll in Medicare (typically at age 65), you get six months when you are guaranteed coverage through Medigap. That is, you can purchase a policy without an insurance company nosing through your health history and deciding whether to insure you.

After that, it can be a different story. In most states, you’ll have to go through medical underwriting.

“They can impose waiting periods for pre-existing conditions, or deny coverage altogether,” she said.

Special exceptions to that include when your Advantage Plan is no longer available or when you are within the first year of enrolling in Medicare and decide to ditch your plan.

While one of the options during the program’s annual open enrollment period — which ends Dec. 7 — is to switch from an Advantage Plan to original Medicare (Part A hospital coverage and Part B outpatient services coverage), it’s important to know its limitations.

For instance, original Medicare has no annual out-of-pocket maximum, unlike Advantage Plans. Additionally, both Parts A and B come with deductibles and limitations on what services are covered and to what degree.

That’s where Medigap policies help. Yet they aren’t a cure-all: For instance, original Medicare does not cover dental and vision expenses, and Medigap policies do not pick up those costs. Advantage Plans, on the other hand, often offer coverage for both.

Also, many Advantage Plans include prescription drug coverage (Part D). If you are on original Medicare — whether you have a Medigap policy or not — you must sign up for a standalone prescription plan unless you meet certain conditions.

Additionally, depending on a combination of factors — the Medigap policy’s features, where you live, and sometimes your age — the cost can reach a few hundred dollars a month.

About 13.6 million Medicare beneficiaries were using Medigap policies to reduce their out-of-pocket outlays in 2017. That’s about 22.5 percent of the 59 million people on Medicare. These policies can only be used with original Medicare, not Advantage Plans.

While about a third of Medicare recipients (19 million) have an Advantage Plan and their ranks have been growing over time, some people discover that their favorite doctor or pharmacy is not part of the plan’s network and decide to remain on (or return to) original Medicare because their doctor accepts it.

Others, such as frequent travelers, want to avoid the limitations that sometimes come with Advantage Plans, such as requirements to visit in-network doctors or pay more, or to get referrals to see specialists.

More from Personal Finance:
Avoid making these three bad assumptions during Medicare open enrollment
What your Medicare agent should do for you
10 states where Medicare Advantage will be the cheapest in 2019

If you were planning to drop your Advantage Plan and pair Medigap with original Medicare, you should consider keeping your current coverage unless you know for sure you’ll be able to get a policy, Johnson said. Also be aware that underwriting can take a month or more.

Additionally, if you already dropped your Advantage Plan and are uncertain about qualifying for Medigap, you can still switch back before the annual open enrollment period ends Dec. 7.

The Centers for Medicare and Medicaid Services has a chart on its website that shows the differences among Medigap policies. You also can use the agency’s search tool to find available plans in your ZIP code. Or, check with your state’s Department of Aging (or similar entity) to find out about free counseling for sorting through your options.

Go to Source

For 300000-plus in Minnesota, Friday Medicare deadline doesn’t apply – Star Tribune

The annual open enrollment period for people selecting a Medicare health plan ends Friday, but that doesn’t mean the shopping season is over for more than 300,000 Minnesotans who are losing their Medicare Cost coverage next year.

Beginning Saturday, people losing Cost plans will be eligible for a special enrollment period where they have until month’s end to buy replacement coverage that takes effect Jan. 1, and enrollment options that stretch into 2019.

Last month, the Minnesota Board on Aging said the Friday deadline applied to Cost plan enrollees who want to buy a stand-alone Part D plan for drug coverage, but it turns out the special enrollment period applies to Part D plans, too.

“We got some clarification on that,” said Kelli Jo Greiner, health policy analyst with the Minnesota Board on Aging. “The urgency is not what it is for the other folks, because [people losing Cost plans] do have a special enrollment period. But the sooner people can make a decision, the better it will be for them.”

For most of the 1 million Minnesotans on Medicare, Friday is the deadline for enrolling in a stand-alone Part D plan, which supplements coverage in the original Medicare program, or a Medicare Advantage (MA) plan, where people obtain Medicare benefits through a private health insurer.

The board on aging expects Friday will be a busy day at the state’s Senior LinkAge Line, which provides free help for people considering their options.

“It’s that crunch time where people that haven’t really given it a thought realize: ‘It’s Dec. 7 and I better do something,’ ” Greiner said.

Medicare open enrollment happens every year, and it’s not an issue for those who rely solely on original Medicare. That’s also true for those who buy a “Medigap” policy that supplements the core government program, since people can apply to purchase supplementary coverage at any time.

But the 2018 shopping season has been unusually hectic due to the change with Cost plans, which are being eliminated by federal law across 66 counties in Minnesota next year.

Those losing the coverage have been encouraged to use the sign-up period to consider original Medicare versus the newer MA plans. State officials say people leaving Cost plans should avoid surprise bills next year by enrolling in an MA plan that includes drug coverage or by supplementing original Medicare with Medigap and Part D policies.

Across the country, about two-thirds of beneficiaries are covered by original Medicare, but a growing number have been picking Medicare Advantage.

Medicare Advantage plans often come with lower premiums than the combined premium for a Medigap and Part D plan. Some MA plans don’t charge a monthly premium. MA plans also offer extras such as vision, dental and hearing benefits.

Original Medicare, on the other hand, provides wider access to doctors and hospitals and gives people a choice of Part D coverage from a variety of companies. While Medicare itself only covers 80 percent of costs in many cases, people who use the government program in tandem with Medigap and Part D coverage can see lower copayments for doctor and hospital care than with MA plans.

Among those losing Cost plans, about 142,000 people are being automatically enrolled in new MA plans from their current insurer, although they are free to make a different choice. Some of those being automatically enrolled in an MA plan are finding their doctor is not in the new health plan’s network, Greiner said, and there are cases where the new MA plan’s drug coverage brings much higher copayment requirements.

People losing Cost plans have a one-time right to buy a Medigap plan without answering questions about their health history, which could block enrollment at a later date. This “guaranteed issue” right extends until March 4.

“We have never had so many requests for information on Medigap policies as we have had this year,” Greiner said.

Even so, Minneapolis-based UCare, which is the state’s largest Medicare Advantage insurer, says it’s had a very busy open enrollment period, with consumers drawn by the combined medical and prescription coverage that’s part of most MA plans.

“On Friday, our team will be onsite and available for phone consultations and enrollments until at least 8 p.m., longer if warranted by volume,” said Wendy Wicks, a UCare spokeswoman, via e-mail. “Online enrollment will be available until midnight as well fax service for applications.”

Blue Cross and Blue Shield of Minnesota, HealthPartners and Medica all sell Cost plans, and those companies for 2019 also are selling Medigap plans and Medicare Advantage plans, depending on the county. Kentucky-based Humana sells Medigap plans as well as Medicare Advantage plans in most Minnesota counties.

In 2019, Minnesotans in certain counties can buy Medicare Advantage plans sold by Minnetonka-based UnitedHealthcare as well as a joint venture between Connecticut-based Aetna and the Allina Health System, which is based in Minneapolis.

Beyond contacting the state’s Senior LinkAge Line (1-800-333-2433) or health insurance companies, consumers can get help from insurance agents, the Medicare.gov website or by phoning Medicare (1-800-633-4227).

 

Go to Source

Open Enrollment for Medicare: Changes You Need to Know About – TheStreet

It’s open enrollment season for Medicare beneficiaries.

And, as in past years, there are changes, especially with Medicare Advantage plans, that might trip you up if you’re not careful, says Katy Votava, president of Goodcare.com and author of Making the Most of Medicare: A Guide for Baby Boomers.

One of them, said Votava, has to do Medicare Advantage plans, and specific medications that some people may be taking most likely in a clinic, and expensive injectable medication, whether it’s for cancer or some other treatment. “And the changes this year that people who have Medicare Advantage plans may be facing a 20% co-insurance for that as opposed to a clinic visit co-pay,” she said in a Retirement Daily podcast.

Thus, a medication — an injectable that might cost $10,000 — will cost someone $2,000 for the 20% co-insurance in 2019.

Votava’s advice: Review your Medicare Advantage plan benefit summaries, especially the section for Medicare Part B and determine if you’ll face increased charges for medications you get, particularly in outpatient clinics.

And if you are facing a cost shift, Votava recommends first looking to see if another Medicare Advantage plan in your area that doesn’t have this type of co-pay structure and percentage for drugs. “They vary down to the county and zip code level,” she said.

And second, “what would work for many people,” she says, is to purchase a Medicare Supplement Insurance or Medigap policy, best case, Plan F or Plan G.”

“These plans will cover their out-of-pocket costs when they use their Medicare Part B benefit, and then add what’s called a standalone drug plan,” Votava said. “Now, that sounds kind of complicated and it can be, so they need to get the show on the road to look for a Medigap plan.”

A Medigap policy helps pay some of the healthcare costs that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles.

Votava noted that people who are older than 65 and three months might find some underwriting and might not be able to change into a Medigap plan, but they might be able to. “If you have a Medigap plan, there’s no network involved in their pricing structure and their cost structure doesn’t exist in those Medigap plans the way it does in Medicare Advantage plans,” she said. “So that’s another way to go — replace that Medicare Advantage with a Medigap plus a standalone drug plan.”

According to Votava, Medicare Advantage beneficiaries can select their plans now, during open enrollment season which runs to Dec. 7, 2018 and, starting in 2019, a new Medicare Advantage open enrollment period will run from Jan. 1 to March 31 every year.

Votava doesn’t recommend that Medicare Advantage beneficiaries change their plans too often if they don’t need to. But if they can’t change their Medicare Advantage/Medigap plans before Dec. 7, they can do so in the first quarter of next year as soon as possible. “And, particularly, if you’re going to move to a Medigap plan plus a drug plan, I recommend that people look for the Medigap plan first, do that application, find out if they’re accepted,” she said. “They might have to apply to more than one company, they might not. And then subscribe for a new Medicare Part D because if you change out of a Medicare Advantage plan in the first quarter of next year, you are entitled to pick up a new standalone D plan at that time.”

In a recent brief, the Kaiser Family Foundation (KFF) provided an overview of the Medicare Advantage plans that will be available in 2019, based on an analysis of data from the Centers for Medicare and Medicaid Services (CMS). In a separate report, KFF noted that people on Medicare will be able to choose among 24 Medicare Advantage plans and 27 Medicare Part D drug plans, on average, during the open enrollment period for 2019.

Read more: Six things to know about Fall Open Enrollment

According to KFF, more than 20 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans, which are mainly HMOs and PPOs offered by private insurers as an alternative to the traditional Medicare program.

For more information, read:

Medicare Advantage Plans in 2019: A First Look

Medicare Part D: A First Look at Prescription Drug Plans in 2019

Medicare Open Enrollment FAQs

To be sure, signing up for Medicare plans can be confusing, but beneficiaries can get free Medicare one-on-one counseling from your state’s State Health Insurance Assistance Program or SHIP. Help can also be found at Eldercare.gov

Votava also said that it’s wise during Medicare’s annual open enrollment period to review your current needs — your care providers, prescriptions, and financial resources — and change plans if there’s one that better suits your needs. “Ninety to 95% of folks on Medicare, as found by major studies by major universities, are overspending,” she said.

Now all this, says Votava, will require a little homework. And one place to do that homework is Medicare.gov, which has section where you can search for the most cost-effective plans, including Medicare Part D and Medicare Advantage plans.

One bit of advice: Buying the plan with the lowest monthly premium might cost you more in the long run, so don’t pick a plan based solely on its premium. “It doesn’t mean you have to buy the most expensive Medicare Advantage plan or Medicare D plan either because even the most expensive ones, if they don’t cover your medications,” may not be the best plan for you, Votava said.

So, a general rule of thumb: Don’t necessarily buy the plan with the lowest nor highest monthly premium. “The lowest may be fine,” she said, but “maybe rarely do you need to spend the most money. Oftentimes, it’s the middle of the road average price plan… You really have to spend the time to make the most of that purchase because it’s the co-payments and co-insurance when you pick up medication or go see a care provider who’s not in network, that’s really more expensive than the premium.”

Votava also noted that changes are coming to Medigap plans. In particular, the best of such policies, Plan F will be discontinued after 2019 — except for those currently enrolled. The next best Medigap plan would be the Plan G, she said. Read more on Medigap plans.

Votava also said Medicare beneficiaries should be aware of changes coming to Medicare Part D as well.

Votava also addressed a recent report issued by the Employee Benefits Research Institute (EBRI) that said some couples could need as much as $400,000 to pay for healthcare expenses in retirement. Read more about healthcare expenses.

Her first suggestion: “How about staying healthy, as healthy as you can, so that you’re not on as many medications as some people would be,” she said. That’s a great investment. It pays you back so many benefits”

Beyond that, she said, “shopping smart is very important to do since most people get it wrong; there’s a huge opportunity to make it better when you do your shopping.”

Also think about healthcare expenses not as a lump sum required at age 65, but as a matter of cash flow. Most people pay for health care in retirement through cash flow — Social Security benefits for Part B premiums, assets and savings for other expenses. Determine how much you will need and where it will come from.

Consider too funding, if you can, a health savings account or HSA. “Health savings accounts are a great way for people to save for their healthcare costs in retirement,” Votava said. “It’s the most tax-preferred savings vehicle in the United States today. Money goes in tax-free, grows tax-free, and comes out tax-free when used for healthcare. So, people who have an option for that who aren’t 65, I say sock away as much as you can into your health savings account because when you take the money out, it’s tax-free additionally.”

Some Medicare beneficiaries might also qualify for financial assistance for Medicare premiums as well, said Votava. 

And lastly, Votava suggested that people contemplate the cost of long-term care, which typically is excluded from studies such as that conducted by EBRI and other groups.

It’s never too late – or too early – to plan and invest for the retirement you deserve. Get more information and a free trial subscription to TheStreet’s Retirement Daily to learn more about saving for and living in retirement. Got questions about money, retirement and/or investments? Email Robert.Powell@TheStreet.com.

Got questions about money, retirement and/or investments? Email Robert.Powell@TheStreet.com

Go to Source

CMA Alert – December 6, 2018

Print Friendly
  1. Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories
  2. In Her Own Words: A Beneficiary’s Take On Medicare Advantage Steering
  3. Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA

Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories

The Medicare Annual Coordinated Election Period (ACEP) is the most crucial time of year for Medicare beneficiaries to make decisions about how they wish to receive their Medicare coverage.  This year the Administration seems to be actively promoting Medicare Advantage plans. However, at the same time that this steering toward private plans is occurring, the Centers for Medicare & Medicaid Services (CMS) reported that Medicare Advantage  provider directories contain extremely inaccurate information, which could lead beneficiaries to sign up for plans that might not actually include their doctors.

This is CMS’ third round of provider directory review since initially being alerted by a beneficiary complaint. CMS Examined 5602 providers and their listed locations from 52 different Medicare Advantage organizations between November 2017 and July 2018.  Reviewers in the study called provider offices to verify the accuracy of the information in the provider directory. Information to be verified included names, address and phone numbers; whether the provider accepted the MA-PD in question at that location, and whether they accepted new patients with the MA-PD in question. CMS assigned each error a score, with incorrect locations, numbers and statements regarding accepting patients weighted highest.[1]

The CMS review found that:

  • Almost half (48.74%) had at least one inaccuracy.
  • Percentage of inaccuracies by MA organization ranged from 4.63% for the best network listing to 93.02% for the worst.
  • The majority of MA organizations had between 30% and 60% inaccuracies.
  • “Providers should not have been listed at 33.14% (3,481) of the locations…either because the provider did not work at the location or because the provider did not accept the plan at the location.”[2]
  • “85.64% of locations with deficiencies…had deficiencies of the highest weighted, most egregious errors.”[3]
  • 41.75% of all locations listed had inaccuracies “with the highest likelihood of preventing access to care.”[4]

Beneficiaries and caregivers rely on provider directories to make important choices about their care. In this era of overt steering toward Medicare Advantage by the Administration[5], accurate information has never been more crucial. Errors in provider listings “create a barrier to care and raise questions regarding the adequacy and validity of the MAO’s network as a whole.”[6] 

Despite these inaccuracies, according to the Washington Post, “[t]he Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence” that CMS “is showing special favor to the alternative program over traditional Medicare offerings.”[7]  The Post continues: “Last year, the agency threatened to impose fines on the plans if they didn’t clean up their act. While this year’s report shows no substantial improvement over last year (or the year before that), CMS isn’t following through on the threat [emphasis in original].”


[1] Online Provider Directory Review Report (Centers for Medicare & Medicaid Services) (November 2018), available at: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/Provider_Directory_Review_Industry_Report_Round_3_11-28-2018.pdf, p. 5, table 3.
[2] Id, p. 6
[3] Id, p. 8
[4] Id, p. 1
[5] In addition to previous Center Alerts, see, e.g. “Trump Administration Peppers Inboxes With Plugs for Private Medicare Plans” by Robert Pear, New York Times, (Dec. 1, 2018), available at: https://www.nytimes.com/2018/12/01/us/politics/trump-medicare-advantage-plans.html, and “The Health 202: Trump administration lets Medicare plans off the hook” by Paige Cunningham, (Dec. 4, 2018), Washington Post, available at:  https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/12/04/the-health-202-trump-administration-lets-medicare-plans-off-the-hook/5c058e4b1b326b60d12800f1/?utm_term=.072d2e85242c.
[6]Online Provider Directory Review Report , p. 1
[7] “The Health 202: Trump administration lets Medicare plans off the hook” by Paige Cunningham, (Dec. 4, 2018), Washington Post, available at:  https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/12/04/the-health-202-trump-administration-lets-medicare-plans-off-the-hook/5c058e4b1b326b60d12800f1/?utm_term=.072d2e85242c.

top


In Her Own Words: A Beneficiary’s Take On Medicare Advantage Steering

Dear CMA,

I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services.

I have become increasingly troubled by the targeted ads to seniors on TV telling viewers that time is running out for them to sign up for Medicare Advantage plans or other similar plans. It sounds as if they don’t sign up for Medicare Advantage they will lose their original Medicare coverage.

There is one particular ad of a woman who misses her train and then equates this to people who don’t sign up for Medicare Advantage or other similar plans.

Where are our original Medicare Plan ads? How are we fighting back? I know that Medicare works for me as well as my husband and find no fault with its coverage. Yes, they only cover 80% of the total bill, but many doctors who accept Medicare have agreed to accept this as full payment minus the deductible.

I am afraid that with so much money being spend on these negative ads, or ads that do nothing but frighten people into thinking that they must sign up for a Medicare Advantage plan or lose their original Medicare coverage, that we will lose the original Medicare Health Coverage that all seniors are entitled to.

I don’t see us fighting back. And we better, sooner rather than later, or we will lose our much deserved and needed original Medicare Health Coverage.

Concerned in New York,
 
A.L.

top


Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA

We have previously written about new guidance from the Administration that will make it easier for states to both ignore Affordable Care Act (ACA) coverage and consumer protection rules, and weaken the ACA Marketplace.

Last week, the Centers for Medicare & Medicaid Services (CMS) issued waiver concepts about how states can implement the new guidance. As Kaiser Health reported, “It is intended to roll back key elements of Obama-era requirements, which were designed to promote enrollment in ACA plans that cover a broad range of medical needs and meet uniform national standards.” In the name of “innovation,” these waivers would virtually allow states to create a separate Marketplace by expanding the use of less comprehensive coverage that does not meet ACA standards. These plans, having lower premiums, would attract younger healthier consumers while leaving older sicker people in ever more expensive ACA plans.

The new guidance also allows states to disregard ACA rules governing the use of subsidies to purchase insurance. The ACA currently restricts the use of subsidies to help low-income consumers purchase ACA-compliant coverage. Under the newly issued guidance, states may expand or further restrict who is eligible for a subsidy or allow subsidies to be used for this junk insurance. States would also be allowed to base subsidies on age instead of income. This is a complete reversal of longstanding policy regulating the use of these subsidies, which is critical to the strength of the ACA Marketplace.

There is some doubt as to whether this guidance from CMS passes legal muster. As the Washington Post reports, “Reps. Richard E. Neal (Mass.), ranking minority-party member of the Ways and Means Committee, and Frank Pallone Jr. (N.J.), his counterpart on Energy and Commerce, dispatched a letter Thursday to the secretary of HHS and two other Cabinet members in which they contended that the waiver concepts are illegal.” In an analysis, the Brookings Institution also casts doubt on the legality and permissibility of this guidance, which was developed outside of a formal rule making process. We strongly urge all federal agencies to be transparent regarding opportunities for public comment and active in promoting such opportunities, in order to gather broad feedback from stakeholders and the public. This is especially true of regulatory matters affecting the health care of millions of consumers.

In a speech last week to the American Legislative Exchange Council, CMS Administrator Verma is quoted as saying “So, I am having a real hard time understanding all of the criticism leveled at this Administration. Critics see subterfuge. The reality…we’ve delivered stabilization.” This is clearly not true. The Center for Medicare Advocacy has extensively highlighted actions taken by the Administration that have weakened not stabilized the ACA. Criticism of the Administration’s actions has certainly been warranted. If it looks like health care sabotage, then it must be health care sabotage.

top

Go to Source

Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA

Print Friendly

We have previously written about new guidance from the Administration that will make it easier for states to both ignore Affordable Care Act (ACA) coverage and consumer protection rules, and weaken the ACA Marketplace.

Last week, the Centers for Medicare & Medicaid Services (CMS) issued waiver concepts about how states can implement the new guidance. As Kaiser Health reported, “It is intended to roll back key elements of Obama-era requirements, which were designed to promote enrollment in ACA plans that cover a broad range of medical needs and meet uniform national standards.” In the name of “innovation,” these waivers would virtually allow states to create a separate Marketplace by expanding the use of less comprehensive coverage that does not meet ACA standards. These plans, having lower premiums, would attract younger healthier consumers while leaving older sicker people in ever more expensive ACA plans.

The new guidance also allows states to disregard ACA rules governing the use of subsidies to purchase insurance. The ACA currently restricts the use of subsidies to help low-income consumers purchase ACA-compliant coverage. Under the newly issued guidance, states may expand or further restrict who is eligible for a subsidy or allow subsidies to be used for this junk insurance. States would also be allowed to base subsidies on age instead of income. This is a complete reversal of longstanding policy regulating the use of these subsidies, which is critical to the strength of the ACA Marketplace.

There is some doubt as to whether this guidance from CMS passes legal muster. As the Washington Post reports, “Reps. Richard E. Neal (Mass.), ranking minority-party member of the Ways and Means Committee, and Frank Pallone Jr. (N.J.), his counterpart on Energy and Commerce, dispatched a letter Thursday to the secretary of HHS and two other Cabinet members in which they contended that the waiver concepts are illegal.” In an analysis, the Brookings Institution also casts doubt on the legality and permissibility of this guidance, which was developed outside of a formal rule making process. We strongly urge all federal agencies to be transparent regarding opportunities for public comment and active in promoting such opportunities, in order to gather broad feedback from stakeholders and the public. This is especially true of regulatory matters affecting the health care of millions of consumers.

In a speech last week to the American Legislative Exchange Council, CMS Administrator Verma is quoted as saying “So, I am having a real hard time understanding all of the criticism leveled at this Administration. Critics see subterfuge. The reality…we’ve delivered stabilization.” This is clearly not true. The Center for Medicare Advocacy has extensively highlighted actions taken by the Administration that have weakened not stabilized the ACA. Criticism of the Administration’s actions has certainly been warranted. If it looks like health care sabotage, then it must be health care sabotage.

Go to Source

In Her Own Words: A Beneficiary’s Take On Medicare Advantage Steering

Print Friendly

Dear CMA,

I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services.

I have become increasingly troubled by the targeted ads to seniors on TV telling viewers that time is running out for them to sign up for Medicare Advantage plans  or other similar plans. It sounds as if they don’t sign up for Medicare Advantage they will lose their original Medicare coverage.

There is one particular ad of a woman who misses her train and then equates this to people who don’t sign up for  Medicare Advantage or other similar plans.

Where are our original Medicare Plan ads? How are we fighting back? I know that Medicare works for me as well as my husband and find no fault with its coverage. Yes, they only cover 80% of the total bill, but many doctors who accept Medicare have agreed to accept this as full payment minus the deductible.

I am afraid that with so much money being spend on these negative ads, or ads that do nothing but frighten people into thinking that they  must sign up for a Medicare Advantage plan or lose their original Medicare coverage, that we will lose the original Medicare Health Coverage that all seniors are entitled to.

I don’t see us fighting back. And we better, sooner rather than later, or we will lose our much deserved and needed original Medicare Health Coverage.

Concerned in New York,
 
A.L.

Go to Source