Some Insight on Medicare Advantage Plans

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Enter the Bounty Hunter Insurance Agents


[By Dr. David Edward Marcinko; MBA]


As a health insurance agent and industry insider for more than a decade, I know first hand that the agents and brokers who enroll senior citizens in Medicare Advantage (MA) plans often make more on those members than the health plans themselves. 


For example, up to $400-600 can be spent on an insurance agent/broker fee by the health plan, contributing to a total member acquisition cost that can exceed 10% of the premium dollar. And, this commission fee or bounty on “grandma” – much like a bulls-eye target on her back – was much higher back in the day. Hence, all the “free” seminars, luncheons, trinkets and other senior citizen freebies cloaked as information dissemination.

Acquisition Costs High

Even if Medicare Advantage plans could deliver the actual health care benefits at a considerably lower cost than traditional Medicare Fee for Service (FFS); it is very possible that the entire savings could be consumed by member acquisition costs.


Now, as a doctor, insurance agent, financial advisor, health economist and future MC patient, I believe that traditional Medicare is a very tough act to follow; and is still the best deal around, by far. Now, try to convince my dad.


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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact:


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12 Responses

  1. Dr. Marcinko,

    You are so right! For example, CMS just stopped WellPoint from marketing, advertising and selling its Medicare health and drug plans.



  2. Jeff and Dr. Marcinko,

    The Centers for Medicare and Medicaid Services [CMS] will now provide beneficiaries with more meaningful choices among Medicare Advantage and Medicare prescription [Part D] drug plans as it continues to build on its oversight efforts.

    The requirements are part of the annual Call Letter, issued by CMS to organizations that intend to offer Medicare Advantage and Prescription Drug plans in 2010. These organizations use this guidance to submit bids on June 1, helping to ensure that beneficiaries have the information they need to choose a plan during the annual enrollment period which begins November 15th.



  3. Jeff and Radcliff,

    MA plans pay about $1,140 more per enrollee than it would cost to care for the same beneficiaries under traditional fee-for-service (FFS) Medicare plans.



  4. Is Medicare Advantage Worth it?

    Read this link and decide:



  5. How Much Medicare Advantage Beneficiaries Could Have Saved in 2013 on Prescription Drugs

    According to data released by eHealth, Inc., only fourteen percent (14%) of people who used eHealth’s online Medicare plan comparison tools were in the Medicare Advantage Prescription Drug plan (MAPD) with the lowest total out-of-pocket costs on prescription drugs available to them. The research also revealed that less than six percent (6%) of people who used eHealth’s comparison tools to compare prices in stand-alone Medicare Prescription Drug plans (PDPs) were in the PDP with the lowest total out-of-pocket costs available to them.

    Users who switched to the plan with the lowest total out-of-pocket costs on prescription drugs in 2013 could have saved an average of $649 over their existing PDP and an average of $634 over their existing MAPD, according to the study. eHealth’s analysis also found that in 2013 the average Medicare beneficiary without any Part D coverage could save an average of $1,266 on prescription drug costs by enrolling in a PDP, and an average of $1,402 on prescription drug costs by enrolling in a MAPD plan.

    Source: eHealth


  6. Proposal Cuts Medicare Advantage Rates by 3.55%

    Medicare is proposing a 3.55% cut in Medicare Advantage rates for 2015, about half of what private insurers were expecting from the federal agency. The final rule will be released April 7. The CMS based its projections on an expected decline of 1.65% in per capita expenditures in the fee-for-service portion of the senior citizen healthcare program. About 15 million or 30% of all Medicare beneficiaries are in Medicare Advantage plans offered by private insurers.

    The CMS estimates that the blended rate of per capita spending on Medicare beneficiaries will decline by 1.9% in 2015. “This historically low growth in Medicare per-capita spending is tied, in part, to successful initiatives undertaken to promote value over volume and help curb fraud, waste and abuse in the Medicare fee-for-service program in recent years,” the agency said in its news release.

    Source: Modern Healthcare [2/21/14]


  7. Ten Counties with Most Medicare Advantage Enrollees as of April 2014

    1. Los Angeles, CA – 564,977
    2. Maricopa, AZ – 241,654
    3. Miami-Dade, FL – 241,338
    4. Orange, CA – 201,121
    5. San Diego, CA – 189,953
    6. Harris, TX – 165,129
    7. Riverside, CA – 163,554
    8. Allegheny, PA – 152,350
    9. Broward, FL – 145,174
    10. Queens, NY – 133,676

    Source: Centers for Medicare & Medicaid Services


  8. Average premium across all MA health insurance plans for 2015 is $62.69

    According to the release of 2015 Medicare insurance data from CMS (analyzed by HealthPocket):

    • The 2015 average premium is only 2% higher than the 2014 average premium of $61.69.
    • The number of $0 Medicare Advantage plans in 2015 has
    decreased 19% since 2014. •The average premium across all Medicare Part D drug plans in the United States for 2015 is $53.90.
    • This is 1% lower than the 2014 average premium of $54.56.

    Source: HealthPocket


  9. Nearly 33.3% Of Medicare Advantage Enrollees Are In PPOs

    According to a recent web briefing from Kaiser Health News:

    • 70% of Medicare enrollees are in Traditional Fee-for-service Medicare.
    • 30% of Medicare enrollees are in Medicare Advantage plans.
    • 64% of Medicare Advantage members are in HMOs.
    • 23% of Medicare Advantage members are in Local PPOs.
    • 8% of Medicare Advantage members are in Regional PPOs.

    Note: Total Medicare Advantage Enrollment, 2014 = 15.7 Million

    Source: Kaiser Health News


  10. CMS 2018 Advance Notice, 5 Takeaways

    1. The average change in Medicare Advantage revenue expected to climb 2.75%.
    2. The average change in Medicare Advantage revenue climb was 3.05% in 2017.
    3. By 2020, it planned to base Medicare Advantage risk scores 100% on encounter data.
    4. In a 2017 Medicare Advantage pay notice, it said it intended to base 50% of payments on encounter data in 2018.
    5. The CMS is proposing a modest increase in baseline Medicare Advantage payment rates for 2018 of 0.25% on average, down from 0.85% last year.

    Source: CMS


  11. Clover Health

    Health-care unicorn, Clover Health is an insurance start-up aiming to use data science to improve preventive medicine. The San Francisco-based company tracks dozens of clinical and social data points to help elderly and low-income patients avoid hospital visits. It currently handles claims for about 25,000 Medicare Advantage patients in New Jersey.

    With a recent $130 million funding round from Google Ventures and other backers, Clover plans to expand and begin operations in three more states by this fall.

    Major investors: First Round Capital, Sequoia Capital, Google Ventures, Greenoaks Capital.

    Dr. David Marcinko MBA


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