The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Update on Medicaid and Medicare Advantage Plans

12 Responses

1. Greg, on April 10, 2010 at 11:48 PM said:

   Health Reform Law Raises Geographic Payments from Medicare

   Among the Medicare program changes made by the new health system reform law were revisions to the geographic adjustments made in calculating payments for physician services. The AMA has developed preliminary estimates of the impact these provisions will have on average payment rates in each of the states, and concluded that physicians in 42 states and territories will benefit from these changes in 2010 and 2011.

   The impact of the revised geographic adjustments on individual physicians will vary by state and by service. But, starting at the beginning of the alphabet to illustrate, the AMA estimates the following increase provided by physicians in Alabama (assuming no change in the fee schedule conversion factor):

   • Payment for a mid-level established patient office visit (CPT 99213) will increase by 4.6 percent, from $59.89 to $62.66.

   Source: AMA Health System Reform Insight [4/9/10]

   LikeLike
2. Grace, on October 4, 2010 at 6:54 PM said:

   Update on Medicare Advantage for HPCH – Bye Bye!

   Harvard Pilgrim Health Care, Massachusetts’ second largest health insurer, is dropping its Medicare Advantage health insurance program at the end of the year. The decision affects 22,000 senior citizens in Massachusetts, New Hampshire and Maine.

   http://www.fiercehealthpayer.com/story/harvard-pilgrim-drops-its-medicare-advantage-plan/2010-10-04?utm_medium=nl&utm_source=internal

   Grace

   LikeLike
3. Richard, on December 9, 2010 at 1:37 PM said:

   Medicare Advantage Fails Cost Test
   [According to NY Podiatrist]

   Medicare Advantage plans have not kept their promise to provide the same services at a lower cost than traditional Medicare, according to Dr. Jaime Torres, regional director of the New York office of the US Department of Health and Human Services [DHHS]. Torres met with the Times Union editorial board recently to talk about Medicare open enrollment and healthcare reform. Torres, a podiatrist and a past president of Latinos for National Health Insurance, was appointed to his post in April by 2010 HHS Secretary Kathleen Sebelius.

   In 2003, Medicare Advantage plans were started as an alternative to original fee-for-service Medicare. The private plans are reimbursed by the federal government for managing the care of enrollees. “When they were created, they thought they would be competitive, that they will offer the same services at a lower cost,” Torres said. But, that hasn’t happened. In fact, “On average, we are paying them $1,000 more per patient for the same services, and that money is subsidized by original Medicare,” he said.

   Source: Cathleen F. Crowley, Albany Times-Union [12/8/10]

   LikeLike
4. Douglas B. Sherlock CFA, on November 2, 2011 at 11:56 AM said:

   ME-P Doctors, Messrs. and Mesdames:

   In 2010, Medicare Advantage plans continued to moderate their growth administrative costs. Per member costs increased by 0.9% on an as-reported basis and declined by 3.9% on a constant mix basis. The median value administrative expense ratio for this group of plans was 8.1%; last year’s ratio was 9.0%.

   These results are excerpted from the Sherlock Expense Evaluation Report Medicare Edition 2011. The ten plans included in the Sherlock study serve 1.0 million Medicare members as well as commercial and Medicaid members. Including additional plans (Independent/Provider-Sponsored and Blue) shown in supplemental exhibits, Sherlock benchmarks comprise the results of 2.2 million members or 18% of the total in the Medicare Advantage program.

   Medicare Advantage now serves nearly 25% of all Medicare beneficiaries. These organizations are increasingly integral to health coverage for Medicare. They show promise as a source of savings for the Medicare program since, according to the Medicare Payment Advisory Commission, Medicare Advantage HMOs bid 97% of fee-for-service costs for such benefits. Approximately two-thirds of all Medicare Advantage members are in HMOs.

   Please find linked below the November 2011 Edition of Plan Management Navigator which summarizes this vitally important study.

   http://www.sherlockco.com/navigator/

   NOTE: We will host a web conference on Thursday, November 3rd from 2:00 PM to 3:00 PM Eastern Time to discuss the summary results of our recently published Sherlock study of the operational costs of Medicare plans. The attached Plan Management Navigator provides background for the web conference.

   During the web conference, I will offer a brief presentation and will answer questions. To participate in the web conference, please register at: https://www2.gotomeeting.com/register/130328818 .

   Once registered, dial-in information and a link to connect to the web will be provided in a confirmation email. Please note that if more than one person from your firm would like to participant in the conference call and the participants will all be in one room, only ONE person must register for the conference.

   We look forward to your participation on Thursday.

   Sincerely,
   Douglas B. Sherlock, CFA

   LikeLike
5. Insurance Agent, on November 15, 2011 at 2:17 PM said:

   MA Plans,

   After passage of the PP-ACA, insurance companies and their agents are finding Medicare Advantage [MA] plans an attractive [lucrative] market opportunity, and are competing very hard for the business.

   [An] Insurance Agent

   LikeLike
6. Bertha, on December 27, 2011 at 2:20 PM said:

   Medicare Advantage Plans

   Perhaps, not so good, after all:
   http://www.politico.com/news/stories/1211/70654.html

   Much like Russian roulette. And, the challenge of hospital billing is formidable.

   Bertha

   LikeLike
7. Ann Miller RN MHA, on December 12, 2013 at 6:39 PM said:

   How Often an Appointment for Routine Care Could be Made as Soon as Needed In The Last Six Months

   Always Usually Sometimes Never

   Traditional Medicare: 62% 26% 10% 2%
   Medicare – Advantage: 62% 25% 10% 3%

   Source: Kaiser Family Foundation

   LikeLike
8. Ann Miller RN MHA, on March 3, 2014 at 6:03 PM said:

   Estimated Payment Reduction in 2015 for Medicare Advantage Organizations

   ACA quartile impact for 2015: -2.4%
   Change in plans’ star rating for 2015: 0.4%
   Elimination of bonus for 3.0 and 3.5 stars for 2015: -1.9%
   Elimination of applicable amount bonus: -0.1%
   Ratebook change for 2015: -1.9%
   Projected insurer fee for 2015: -0.8%
   Coding intensity change for 2015: -0.25%
   Risk Score normalization factor for 2015: -3.2%
   Elimination of home assessment visit diagnoses: -2.0%
   Total Reduction for 2015: -5.9%

   Source: Oliver Wyman

   LikeLike
9. Ann Miller RN MHA, on September 18, 2014 at 6:05 PM said:

   30% of Medicare beneficiaries are enrolled in a Medicare Advantage plan

   According to the Kaiser Family Foundation:

   • Approximately 30% of Medicare beneficiaries are enrolled in a Medicare Advantage plan.
   • Approximately 70% of Medicare beneficiaries are enrolled in a Traditional Medicare plan.
   • 64% of all Medicare Advantage enrollees are enrolled in HMOs.
   • 31% of all Medicare Advantage enrollees are enrolled in PPOs.
   • 5% of all Medicare Advantage enrollees are enrolled in PFFS/Other.

   Source: Kaiser Family Foundation

   LikeLike
10. Eric, on October 2, 2014 at 11:55 AM said:

    Questions for reporters to ask about Medicare Advantage

    Between now and October 15th, when open enrollment begins for Medicare Advantage, health insurers are likely to drop some of their MA plans.

    http://healthjournalism.org/blog/2014/10/questions-for-reporters-to-ask-about-medicare-advantage/

    Eric

    LikeLike
11. Niles, on March 1, 2017 at 4:26 PM said:

    KFF: Analysis Review of Medicare Advantage Plans Offered in 2017, Key Takeaways

    1. The average Medicare beneficiary will be able to choose from 19 plans in 2017, a number which has been relatively stable since 2012.
    2. While premiums have been relatively flat, average limits on out-of-pocket costs for Part A and B benefits have increased by 25 percent since 2011, from $4,281 in 2011 to $5,332 in 2017.
    3. About one-quarter of beneficiaries will have a choice of plans offered by three or fewer firms in 2017.
    
    Source: Kaiser Family Foundation

    LikeLike
12. Ann Miller RN MHA, on November 21, 2019 at 7:26 PM said:

    The Average Medicare Advantage Monthly Premium is $5.47 in 2020

    eHealth recently released an analysis of Medicare Advantage plan price and enrollment trends for 2020. Here are some key findings from the report:

    • $5.47 is the average monthly premium for Medicare Advantage plans in 2020.
    • The average Medicare Advantage premium fell 43% from $9.53 in 2019.
    • 83% of all eHealth Medicare Advantage customers selected $0 premium plans for 2020.
    • 3 in 4 of eHealth Medicare Advantage customers chose plans with $0 premiums in 2019.

    Source: eHealth, November 14, 2019

    LikeLike