By Jeffrey White Medicare/Medicare Advantage plans are open to change enrollment now through December 7. As a result, you have probably seen advertisements for many Medicare Advantage plans. There are several options in our market area if you decide an Advantage plan is right for you. But don’t assume because it’s an AARP-endorsed company, that it’s the best possible choice for you. What you need to know is which providers belong to the plan’s network. A doctor or hospital “in network” is one that negotiates a formal contract and provisions for reimbursement. This is important because, if you receive services from a doctor or hospital out-of-YOUR-network, you may find yourself with less coverage and paying much more out-of-pocket than you bargained for! Medicare Advantage plans are not supplemental plans, they actually replace traditional Medicare. Sometimes called “Part C” or “MA Plans,” a Medicare Advantage Plan is another health plan choice you may have as part of Medicare. They are offered by private insurance companies and provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage Plans pay for all of the services that Medicare covers, including emergency and urgent care. These plans are NOT supplemental coverage, but they may offer extra benefits, such as vision, hearing, dental and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). Although participating insurance companies must follow rules set by Medicare, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services. For instance, you may need a referral to see a specialist or you may be required to go only to doctors or facilities that belong to the plan for non-emergency or non-urgent care. Or you may be required to obtain prior approval for certain procedures to avoid higher costs. If you are treated by a doctor or hospital that doesn’t belong to the plan, your services may not be covered or your costs could be higher. Since not all Medicare Advantage Plans work the same way, it’s important to find out the rules and costs of a plan — and if your doctors and hospital are in the plan’s network of providers — before you sign up. In most cases, you’re enrolled in a plan for a year and cannot change plans until the next open enrollment, which could be up to one year later. Insurance companies offering Medicare products may say you are free to choose any doctor or hospital, but some fail to let you know that you may pay more for medical care by providers (doctors and hospitals) not in their network. If you are already in a plan and do not select a different insurance company, you will be automatically re-enrolled in your current plan. Be aware, the plan’s rules and participants can change each year, so you’ll need to confirm your health care providers are still part of the insurance company’s network. Beaufort Memorial Hospital participates in five Medicare Advantage Plans. They are: • Medicare-Ambassador PPO (MCR Advantage plan under America’s 1st Choice) • Medicare-Blue (MCR Advantage PPO plan) • Medicare-Humana Choice PPO (MCR Advantage PPO plans) • Medicare-Humana Gold Choice PFFS (MCR Advantage plan) • Medicare-Patriot PFFS (MCR Advantage plan under America’s 1st Choice) To find out more about plans available in the area, go to www.medicare.gov and enter your zip code. If you want more information about Beaufort Memorial’s participation in a specific Medicare Advantage Plan, visit www.bmhsc.org or call Robin Poehnert at 522-5794. Remember, you only have until December 7 to choose a different Medicare Advantage plan, or you may choose to switch back to traditional Medicare. Whichever you choose, make sure you know what you are getting before you sign up and that you understand the implications and requirements of joining a particular Medicare Advantage plan. Jeffrey White is Senior VP and CFO at Beaufort Memorial Hospital.
Video: What Is Medicare Advantage?
Early Evidence Suggests Medicare Advantage Pay For Performance May Be Getting Results
The ACA phases out higher payments previously given to all MA plans. Instead, Medicare in 2012 began paying bonuses only to plans with strong performance on clinical quality, service measures and patient experience of care measures. Medicare bases the 2012 bonus payments on 2011 plan performance, as rated by a five-star system. This system incorporates Health Effectiveness Data Information Set (HEDIS®) and other quality measures, Consumer Assessment of Health Plans (CAHPS®) patient experience results (See Note 1 below.), and results of the Health Outcomes Survey (HOS) that tracks patient-reported outcomes over time. It also includes metrics such as complaints Medicare received about the plan, customer service for drug benefit plans, and beneficiary access and performance problems identified in audits by Medicare.
Medicare Advantage Future
It appears that the Advantage plans eventually will be limited to lower incomes where it will be based on people on medicaid or dual eligible. It simply can’t go to the way of having one area in the country offer it and not in others. Can this be unconstitutional? Insert from the congress blog:The candidates’ positions on Medicare Advantage – The Hill’s Congress Blog "Medicare Advantage plans are paid based on a legislative formula, and any payments they receive above what is necessary to provide the basic Medicare benefit must be provided to the beneficiaries of the plans in the form of expanded benefits, such as lower deductibles and copayments for services. Once the election is over and the artificial and temporary bump-up in payments is terminated, as it inevitably will be, the Medicare Advantage plans will be forced to pare back benefits, and enrollment in the plans will drop." "This should not be surprising. The traditional Medicare fee-for-service insurance is an extremely inefficient model. There is no incentive for either the providers or the enrollees (most of whom have supplemental coverage beyond Medicare) to control the use of services. Thus, the volume and intensity of service use rises dramatically each year. Moreover, there is no coordination among those providing medical services to the patients, which leads to fragmented and low-quality care in too many instances." Since traditional med sups are considered inefficient in controlling costs and the fact the president wants to cut spending on advantage plans it leaves a big gap of uncertainty of which way we go with medicare. I would hope we get rid of the political animal and try to come up with the most efficient way to run medicare for future generations to come as the country ages. What is your take?
Medicare Targets Health Plans With Low Ratings
Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
How much does Medicare Advantage cost?
Plans with $0 Monthly Premiums: Among the 43,306 plans available in 2013, 13,741 plans (32 percent) will be offered at a cost of $0 above what a Medicare beneficiary already pays for Medicare Part B. By comparison, 14,297 plans (33 percent) were available with a $0 monthly premium in 2012 and 13,821 plans (35%) were available in 2011.
Obamacare ‘Surprise’ Threatens Access to Medicare Advantage Coverage, AMAC Charges
The Association of Mature American Citizens [http://www.amac.us] is a vibrant, vital and conservative alternative to those traditional organizations, such as AARP, that dominate the choices for mature Americans who want a say in the future of the nation. Where those other organizations may boast of their power to set the agendas for their memberships, AMAC takes its marching orders from its members. We act and speak on their behalf, protecting their interests, and offering a conservative insight on how to best solve the problems they face today.
OPINION: Who wins with Medicare Advantage?
Over the past several years, the largest insurers — Unitedhealth, WellPoint, Aetna, Cigna and Humana — have reported record profits, even during the quarters when enrollment in their employer-based and individually purchased health plans declined because of the recession. They’ve been able to do this in two ways: by taking in significantly more in premiums from their commercial customers than they have paid out in medical claims, and by persuading increasing numbers of retirees to enroll in their Medicare Advantage plans. If you enroll in one of their plans, the government sends a check to the insurance company you choose for your coverage. The amount varies depending on where you live. You might have to pay an additional premium out of your own pocket for better drug coverage, a broader network of providers, reduced copayments and discounts on gym memberships.
What Is Medicare Advantage Insurance?
What is Medicare Advantage insurance? Now that you can answer that basic question, let’s explore Medicare Advantage further so you can see how well it can go above traditional Medicare. The types of additional benefits offered may include vision care, health and wellness programs, hearing and dental. The dental benefit cannot be underestimated as traditional Medicare only covers dental services when they are deemed essential to the maintenance of your health or critical to the success of a non-dental operation. However, things such as prescription drug coverage, routine dental checks, fillings, cleaning or basic preventative maintenance are not covered under traditional Medicare. Some Medicare Advantage plans do offer that benefit. In fact, some Medicare Advantage plans offer coverage which competes directly with the combined coverage of traditional Medicare plus a Medicare Supplemental Insurance policy.
Obama administration hides Medicare Advantage cuts in demonstration project
“Over the next few years the Affordable Care Act cuts about $156 billion worth of subsidies from Medicare Advantage plans,” Herrick said. “Nearly one in four seniors are enrolled in a Medicare Advantage plan. Half of these may lose their plans, as plans that are no longer profitable close due to the budget cuts. However, millions of seniors being thrown off their private Medicare plans in an election year is not something that’s welcome by the Administration.