From the category archives: Medicare Advantage
Sometimes we hate it when we’re right. Earlier this month we reported on the Obama administration’s policy reversal which not only blocked proposed cuts to massive private insurers in Medicare but actually give them a rate increase. As predicted, as soon as Washington gave the nation’s highly profitable private insurance industry their cookie --they asked for the milk.
Kaiser Health News explains how United Health’s CEO claims the company’s $2.1 billion profits last quarter just aren’t enough. They want taxpayers to pony up even more to subsidize their participation in Medicare.
KAISER HEALTH NEWS
If the Obama administration expected the biggest health insurance company to give thanks for this month’s decision to reverse cuts to private Medicare plans, it was wrong. UnitedHealth Group CEO Stephen Hemsley said Thursday that Medicare Advantage rates are still far too low and that the company may shrink its business of managing care for seniors.
“We did not expect the fastest growing, most popular and most effective Medicare benefit option serving America’s seniors to be underfunded to this extent in 2014,” Hemsley said on a conference call with investment analysts. UnitedHealth’s Medicare Advantage business, he added, “will likely experience market exits as well as in market membership contraction as we reshape Medicare networks and benefits to respond to the continuing underfunding of this program.”
The administration’s decision to reverse cuts for Medicare Advantage, in which private insurers operate managed care networks for seniors, was seen as a significant industry victory. As the biggest seller of Medicare Advantage plans, UnitedHealth was deemed a primary beneficiary. More than one Medicare member in four is in a Medicare Advantage plan.
In February the Department of Health and Human Services surprised insurers by announcing a cut of more than 2 percent per Medicare member for 2014. The industry launched a lobbying and advertising campaign in protest. On April 1, the administration pulled back, announcing that instead of reducing payments it would raise them by 3.3 percent. UnitedHealth’s stock stock rose 8 percent that day and the next.
But in Thursday’s call to discuss the company’s quarterly profits of $2.1 billion on revenue of $30.3 billion, Hemsley said other changes — including the Affordable Care Act’s long-term reduction in Medicare Advantage payments – would still lead to a net reduction next year of more than 4 percent. That’s inadequate when medical costs are rising in the 3 percent neighborhood, he said.
While the nation waits for the Supreme Court’s decision on the Affordable Care Act, we think it’s important that the real-world implications of this decision for millions of American seniors not get lost in the shuffle.
Here is an analysis of the impact on seniors’ Medicare and Medicaid benefits if the ACA is completely overturned:
If the individual mandate is declared unconstitutional and is not severed from the rest of the law the whole ACA would be struck down.
All of the provisions which positively impact senior’s health would be stripped away.
The Part D Donut Hole will return. Prescription drug costs will rise because discounts provided by ACA will be revoked.
Beginning in 2011, brand-name drug manufacturers provided a 50% discount on brand-name and biologic drugs for Part D enrollees in the donut hole. By 2013, Medicare would have begun to provide an additional discount on brand-name and biologic drugs for enrollees in the donut hole. By 2020, Part D enrollees would have been responsible for only 25% of donut hole drug costs. All of these savings will be gone if the ACA is repealed
New Preventive Services provided with the ACA will disappear.
Savings for Chemotherapy and Dialysis patients in Medicare Advantage plans lost
- Prior to the ACA, Medicare beneficiaries were required to pay a deductible and 20% co-pay for many preventive health services.
- The ACA eliminated cost-sharing for many preventive services and introduced an annual wellness visit for beneficiaries.
- The ACA also eliminated cost-sharing for screening services, like mammograms, Pap smears, bone mass measurements, depression screening, diabetes screening, HIV screening and obesity screenings.
Improvements in care for individuals with chronic conditions gone
- In the past, Medicare Advantage plans have had flexibility to impose cost-sharing structures that differ from traditional Medicare. Prior to the ACA, plans increased co-insurance for some services, like chemotherapy and dialysis. Beneficiaries who were enrolled in MA plans that needed those services were left worse off than if they had the same conditions and were in traditional Medicare. Many beneficiaries enrolled in these plans did not understand the differences in cost sharing.
- The ACA attempts to remedy this by preventing Medicare Advantage plans from imposing higher cost-sharing for chemotherapy and dialysis than is permitted under Medicare Parts A and B.
- The Centers for Medicare and Medicaid Services (CMS) issued final regulations on these improvements in 2011, and many became effective January 1 of this year.
Improvements to help seniors transition from the hospital back home repealed
- The ACA has several provisions targeted to improving the quality of care for patients with chronic illness and reducing the costs to Medicare and Medicaid for serving those beneficiaries.
Improvements in seniors’ access to primary care physicians lost
- The ACA established the Community-Based Care Transition Program which targets individuals who are in traditional fee-for-service Medicare and are hospitalized and at risk for readmission. The program provides grants to hospitals to work with community-based organizations to provide transitional care interventions.
- 30 community-based organizations across the country have already partnered with local hospital systems and are committed to reducing readmissions by 20% and hospital acquired conditions by 40%.
Medicare’s Trust Fund will face insolvency 8 years (or even more) sooner than expected
- Through the Independence at Home demonstration, that ACA will pay physicians and nurse practitioners to provide home-based primary care to targeted chronically ill individuals for a three-year period.
- CMS recently launched this primary care initiative with 16 practices across the country.
- The Affordable Care Act includes many measures to control costs as well as models for reform that will increase the solvency of the Medicare. If the ACA is repealed those cost saving measures will be lost and Medicare’s solvency threatened.
The National Committee
has partnered with the highly respected National Senior Citizens Law Center
to provide detailed analysis of the various Affordable Care Act rulings that could come from the Supreme Court. Our full analysis will be available immediately following the Court’s ruling, expected soon.
Confused by what health care reform really means for seniors? Join the crowd. Take a few minutes and let this video help break it all down for you...
The Patients Aware
campaign, created by the National Committee to Preserve Social Security and Medicare Foundation, the Herndon Alliance, and the National Physicians Alliance
, has released a new video
to help America’s seniors understand the new Medicare benefits available to them thanks to the Affordable Care Act. The video, “Did You Know?”
, highlights new preventive benefits for seniors, Part D coverage improvements like closing the donut hole, and describes how savings have already reduced Part B premiums for seniors. The video can be seen on the Patients Aware website at: www. Patientsaware.org.
has assembled a national network of doctors, nurses, and other healthcare experts to give Medicare presentations during educational meetings and town halls beginning in March. Medical professionals are among the most trusted sources of health care information for seniors and their families. They understand how vital Medicare is to the health and wellbeing of their older patients which is why they have agreed to donate their free time to provide information and answer questions for seniors in cities throughout the country.
“America’s seniors want and deserve the facts about Medicare, prescription drug policy, and what federal health reform will mean for them. Most Americans know very little about the important new benefits and protections provided by the Patient Protection and Affordable Care Act. The National Physicians Alliance has found that providing non-partisan, factual information about the law is the best antidote to widespread confusion and anxiety.” Dr. Valerie Arkoosh, NPA President
The video release and town hall tour follows a successful December 2011 campaign kick off in which more than sixty thousand Americans participated in a Patients Aware
tele-town hall with Assistant Secretary for Aging Kathy Greenlee, and a panel of doctors, nurses, and healthcare policy experts. Seniors and their families dialed in to this national forum to ask questions about the Affordable Care Act and what it means for millions of Medicare beneficiaries. The hour-long event kicked-off one of the most effective education efforts to date since the law was passed in March 2010.
Online “Plan Finder reviews 2012 plan options
In advance of the new, earlier annual enrollment period, CMS has opened up it's plan finder earlier too...people with Medicare coould begin reviewing plan benefit and cost information on Saturday, October 1st, 2011. The Centers for Medicare & Medicaid Services (CMS) will launch access to its popular web-based Medicare Plan Finder
that allows beneficiaries, their families, trusted representatives, and senior program advocates to look at all local drug and Medicare Advantage (Part C) plan options that are available for the 2012 benefit year. From the CMS news release:
“With Open Enrollment coming early this year, it is important that people with Medicare take advantage of the next couple weeks to review their current coverage and compare it with the options that are available for next year,” said CMS Administrator Donald M. Berwick, M.D. “The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs.”
The annual enrollment period begins earlier this year, on October 15th, and runs through December 7th. People with Medicare will have seven weeks to review Medicare Advantage and Part D prescription drug coverage benefits and plan options, and choose the option that best meets their unique needs. The earlier open enrollment period also ensures that Medicare has enough time to process plan choices so that coverage begins without interruption on January 1, 2012.
People can use the Plan Finder – available at Medicare.gov
–by inserting their home zip code to find out which Medicare Advantage (Part C) and Prescription Drug (Part D) plans are available in their areas.
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