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From the category archives: Medicare Advantage

Medicare Inertia Costs Seniors Millions Each Year

It’s Open Enrollment season...have you looked at your Medicare Part D and Advantage plans to ensure they still work for you?

Each year, both Medicare Advantage and Part D plans make changes to their benefits, cost-sharing, provider networks and monthly premiums. That means the plan that best served you in 2016 may not be the best plan for you next year.

US News reports:

“According to a recent analysis by the Kaiser Family Foundation, roughly 8 in 10 people enrolled in a Part D or Medicare Advantage plan stick with the same policy from one year to the next. That may be the path of least resistance, but it's probably not the cheapest. Last year, eHealthMedicare.com found that people willing to switch policies to one that offered better coverage for their particular drug regimen saved roughly $600 on prescription drug costs when they switched Part D plans. Savings jumped to more than $1,000 for those who changed their Medicare Advantage plans.”

We certainly understand why so many beneficiaries choose inertia rather than the tedious and often challenging task of comparing the various private insurance plans offered in Medicare Advantage and Part D. However, given that Americans 65 and older spend 12% (and more as they age) of their income on health care, it’s especially important that seniors take the time to ensure last year’s plans still meet their needs. 

Open enrollment continues through Dec. 7.  You’ve got a some time left so please take a look at your plans. 

Vast Majority of Private Medicare Advantage Plans Overcharged the Government

New analysis by the Center for Public Integrity of Medicare Advantage audits show that 35 of the 37 companies audited by the Centers for Medicare & Medicaid Services (CMS) overcharged the government by millions of dollars each year. By “upcoding” claims, insurance companies report patients as being sicker than they are and thus collect higher payments from Medicare. 

By overstating the severity of medical conditions like diabetes and depression, extra payments are made to health plans which claimed some diabetic patients also had complications of the disease, such as eye or kidney problems. After the CMS audits, these claims were ultimately reduced or invalidated in nearly half the cases, sometimes more.  This CPI report isn’t the first time private insurers in Medicare Advantage have come under fire. In May, a Government Accountability Office report called for “fundamental improvements” to curb excess charges linked to faulty risk scores.  In addition, at least half a dozen health-industry insiders have filed whistleblower lawsuits that accuse Medicare Advantage insurers of manipulating risk scores to boost profits.

CPI also found: 

Auditors on average could confirm just 60 percent of more than 20,000 medical conditions plans were paid to treat. The confirmation rates were much lower for some conditions, such as diabetes with serious complications, depression and some forms of cancer.

Overpayments triggered by unsupported medical diagnoses at the 37 plans audited topped $10,000 per patient for more than 150 patients. The health plans overcharged the government by $2,000 or more for at least 3,500 people in the 2007 sample group.

The health plans overall were three times as likely to charge Medicare too much as too little for some of the 70 medical conditions examined as part of the audits.

None of the plans faced closer scrutiny following the audits, no matter the size of the overpayment. The 2007 audits, which collected a total of $12 million in overpayments, are the only ones CMS has completed since officials adopted risk scores in 2004 at the behest of Congress. In some cases, health plans are still appealing the results, nine years later.  

17 million seniors are enrolled in Medicare Advantage and in 2014, Medicare paid the health plans more than $160 billion. The Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years.

GOP Appropriators Want to Eliminate Funding for Medicare SHIP Programs

 

Each day 10 thousand Americans become eligible for Medicare.  The aging of the baby boom generation certainly isn’t a surprise to anyone and yet, instead of boosting programs to serve this increased need, Republican Congressional leaders continue to slash and now eliminate programs designed to help millions of aging Americans and their families. 

The latest target is one of the nation’s most effective consumer resources for seniors, the Medicare State Health Insurance Assistance Program (SHIP)

“The SHIP network provides critical information upon which people with Medicare rely to make informed decisions about their coverage options and enrollment decisions,” says Judith A. Stein, Executive Director, Center for Medicare Advocacy, Inc. “The SHIPs are critical to providing assistance with these increasingly complicated choices. People with Medicare and their families from all over the country depend on SHIPs as the key source of unbiased guidance.” 

Incredibly, the Senate Appropriations Committee approved a Fiscal Year 2017 budget appropriations bill that completely eliminates the $52.1 million in funding for SHIP. 

“Senate appropriators have turned their backs on a growing number of people who will need SHIP services to navigate the complexities of Medicare coverage by proposing to eliminate program funding. This kind of penny-wise, pound-foolish lawmaking will threaten the economic security of millions of Medicare beneficiaries and their families.”…Max Richtman, NCPSSM President/CEO

“Understanding the complexities and decisions required for Medicare is an overwhelming, isolating experience for seniors, people with disabilities, and caregivers who don’t know where to get help. For millions of Americans, their only option for that help is their SHIP. If SHIPs disappear, there is no replacement for the critical services they provide. The loss of SHIPs threatens the economic security and the health of all current Medicare beneficiaries and the thousands who become eligible every day.”…James Firman, President and CEO of the NCOA 

"Eliminating SHIPs would leave millions of older Americans, people with disabilities, and families who need help comparing coverage options, appealing denials, applying for financial assistance, and navigating an evolving and increasingly complex program stranded—with nowhere to turn. With 10,000 Baby Boomers aging into Medicare each day, it is imperative that the U.S. House of Representatives reject this unprecedented, nonsensical cut."…Joe Baker, President of the Medicare Rights Center

In case you have any doubt about the need for SHIP services consider this:  today’s Medicare beneficiary must choose among more than 20 prescription drug plans, an average of 19 Medicare Advantage plans, as well as various Medigap supplemental insurance policies—all with different premiums, cost sharing, provider networks, and coverage rules. SHIPs also help beneficiaries resolve fraud and abuse issues, billing problems, appeals, and enrollment in low-income health assistance programs. In 2015, SHIPs provided one-on-one assistance to more than seven million individuals and in the past decade, the number of beneficiaries receiving personalized counseling from SHIPs has tripled.

Not a day goes by that we don’t hear horror stories of seniors and their families who face severe economic hardship and even bankruptcy because of a bad choice made in their healthcare options.  That’s exactly why SHIP is so vitally important.    

We’re proud to join a coalition of aging organizations including; The Center for Medicare Advocacy, Medicare Rights Center, and National Council on Aging (NCOA) to fight for a reversal of this outrageous Senate move to eliminate seniors’ access to desperately needed SHIP services.

We urge you to call your Senators and Representative and tell them:  Americans Need SHIP.

 

1-800-998-0180

New Report Shows Ethnic Discrepancies in Medicare Advantage

For the first time, the Centers for Medicare and Medicaid Services has released data on the racial disparities reported by Medicare Advantage patients. 

Despite advances in healthcare access, increases in spending, and improvements in quality over the last decade, there is well-documented evidence that members of racial and ethnic minority groups continue to experience worse health outcomes, CMS said.

The data in disparity of care for eight patient experience measures shows that in seven areas, Asians and Pacific Islanders rated their experience in scores worse than that of whites, compared to five areas for Hispanics, three areas for blacks and only two areas for American Indians and Alaska natives...Healthcare Finance News

The CMS report surveyed customer service responses in a variety of categories. In categories of how easy it is to get needed care; getting needed prescription drugs; and getting information from their health plan about prescription drugs, whites gave the highest ratings, according to the survey.

In a question of getting appointments and care quickly; getting customer service from a health plan; and care coordination, American Indians/Alaska natives gave the highest scores. Blacks gave the highest score when asked how well doctors communicate with them. Asians and Pacific Islanders gave the highest score in a question of getting an annual flu vaccine.

"These data are a good first step in understanding disparities in Medicare Advantage," said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. "We look forward to working with plans in closing the differences in the quality of care that people with Medicare Advantage receive." 

Achieving Health Equity will also be the topic of a Congressional forum later this week, hosted by House Energy and Commerce Committee Democrats in partnership with the Congressional Black Caucus (CBC), Congressional Hispanic Caucus (CHC), and Congressional Asian Pacific American Caucus (CAPAC). 

The Economic Crisis Candidates Continue to Ignore

The Economic Policy Institute’s “The State of American Retirement” combined with the National Institute on Retirement Security’s new report on women and retirement paint a very clear picture of a nation on the brink of an economic crisis that will devastate millions of average American families, if Washington continues to turn a blind eye.

The median family between the ages of 32 and 61 has only $5,000 saved in a retirement account, while the top 1 percent of families has a million dollars or more. For many groups—lower-income, black, Hispanic, non-college-educated, and unmarried—the typical working-age family has no savings at all in these accounts....The State of American Retirement.

“Our retirement system used to reduce inequality, but since the shift to 401(k)s it has only served to magnify it. These accounts are accidents of history that were never designed to replace pensions, and it should come as no surprise that they have not worked for the majority of people.” ...Monique Morrissey, EPI Economist

The numbers are stark:

  • Nearly half of all working-age families have zero retirement savings.
  • Almost nine in 10 families in the top income fifth have savings in retirement accounts, compared to fewer than one in 10 families in the bottom income fifth.
  • Only 41 percent of black families and 26 percent of Hispanic families have retirement account savings, compared with 65 percent of white non-Hispanic families.
  • Only married couples are more likely than not to have retirement account savings.

News that the income inequality hindering American workers now is also carrying over to their retirement is alarming for future generations who are taking an economic hit at every stage of life.  For women, the retirement picture is even worse. 

“A new analysis finds that women are 80% likely than men to be impoverished in retirement. The National Institute on Retirement Security (NIRS) finds that across all age groups, women have substantially less income in retirement than men. For women age 65 and older, the data indicate that their typical income is 25 percent lower than men. As men and women age, men’s income advantage widens to 44 percent by age 80 and older. Consequently, women were 80 percent more likely than men to be impoverished at age 65 and older, while women age 75 to 79 were three times more likely to fall below the poverty level as compared to their male counterparts.”... National Institute on Retirement Security

Just as we’ve seen from climate change deniers, many Republican politicians won’t even acknowledge the retirement crisis exists because improving the nation’s most successful federal retirement programs is anathema to their misguided belief that Wall Street should be handling your savings and for-profit insurance companies managing your health. Instead of supporting proposals to improve the backbone of America’s retirement system, Social Security and Medicare, conservatives continue their campaign to privatize and cut. 

There are legislative proposals which would improve Americans’ retirement picture but they are languishing in the GOP controlled Congress.  You can see many of these proposals on our Legislative tracker.  We also continue to advocate for meaning changes impacting retirement security for women.  Please take a moment and see those details on our Eleanor’s Hope initiative website. 

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