Medicare.gov: the official U.S. government site for Medicare
Obamacare’s Impact on Medicare Advantage
Build on the steady progress in risk adjustment. Risk adjustment is a tool used to address selection bias in Medicare Advantage and other private insurance programs. The goal is to mitigate an insurer’s ability to tailor plans to attract a disproportionate share of the most profitable enrollees—healthier enrollees that consume less medical services. Every major Medicare reform proposal, based on premium support, would provide risk adjustment or significantly improve the risk-adjustment formulas or mechanisms that currently exist in the MA or Medicare Part D program. Risk adjustment could either be prospective or retrospective. Prospective risk adjustment already characterizes Medicare Advantage and Medicare Part D, where government per capita payments are adjusted by demographic factors, such as age, sex, institutional or Medicaid status, and medical conditions. Retrospective risk adjustment—back-end adjustments—would be based on new pooling arrangements, such as a risk-transfer pool. In that arrangement, health plans that attracted higher-risk or more costly patients would be cross-subsidized by plans that attracted fewer high-risk or less costly patients. The value of these types of arrangements is that they would be based on hard data and not on educated guesswork or projections. The Wyden–Ryan plan, for example, includes such an approach. The Heritage proposal would include both prospective and retrospective risk adjustment. Applying the lessons from MA’s risk-adjustment experience could mitigate the risks that only the unhealthy would be stuck in Medicare fee-for-service plans, leaving the plans’ costs to escalate and grow further away from the premium support benchmark, and thus more expensive for enrollees. Over the past decade, as Alice Rivlin and others have noted, the risk-adjustment mechanism used in Medicare Advantage has significantly improved and succeeded in reducing favorable selection in the program. In the future, with the adoption of defined-contribution financing for the entire Medicare program, one can expect further refinements and innovative approaches to adjusting government per capita payments. One particularly interesting approach has been developed by Zhou Yang, professor of economics at Emory University. Professor Yang’s proposal, to be implemented within an environment of competitive health plans, would tie Medicare payments to positive behavioral changes: Enrollees would be rewarded for enrollment in wellness or preventive-care programs that promote a healthier (and thus less costly) lifestyle.
2016 Medicare Advantage Plan Comparison
The plan comparison tool featured on the next pages is provided by eHealthMedicare and is designed to help you compare selected stand-alone Medicare Part D prescription drug plans, Medicare Advantage plans with prescription drug coverage (also known as MAPDs), Medicare Advantage plans without prescription drug coverage (MAs), and some types of Medicare Supplements or Medigap plans. For a complete list of plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. The Annual Open Enrollment Period (AEP) for stand-alone Medicare Prescription Drug Plans (PDPs) and Medicare Advantage plans (MAs & MAPDs) is October 15th through December 7th with the newly selected plan taking effect January 1st of the following year. Anyone eligible for Medicare Part A and/or Part B can enroll or switch Medicare Part D plans during the AEP. To enroll in a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Part B. When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium. The Annual Medicare Advantage Dis-Enrollment Period (MADP) for Medicare Advantage plans is January 1st through February 14th — during which time Medicare Advantage plan members can switch back to Original Medicare and enroll in a stand-alone Medicare Part D drug plan. People who are new to Medicare have a seven (7) month period (called an Initial Enrollment Period) to enroll in a Medicare Part D or Medicare Advantage plan. This enrollment window begins 3 months before your month of eligibility, and includes your month of eligibility and three months thereafter. Example: If you turn 65 on July 13th. Your month of Medicare eligibility is July. Your Initial Enrollment Period (IEP) is April to October. If you were to enroll between April 1 and June 31, your plan would take effect on July 1. If you enroll between July 1 and October 31, your plan would take effect the first day of the month after you enroll. A Special Enrollment Period (SEP) may be granted to some people in certain situations allowing them the opportunity to enroll or switch plans outside of the Annual Open Enrollment Period (AEP). Click here for a list of SEPs.
Medicare Plan Finder for Health, Prescription Drug and Medigap plans
Medicare Advantage 2014 Spotlight: Plan Availability and Premiums
While many organizations offer Medicare Advantage plans, a few – particularly Humana, United Healthcare, and the Blue Cross and Blue Shield (BCBS) affiliates – have particularly large geographic spread and these organizations historically account for a disproportionate share of enrollment. In 2014, 44 percent of available plans are being offered by one of these three firms or affiliates (Table A4). Plans offered by these firms are available to most beneficiaries. Nationwide, 83 percent of Medicare beneficiaries will have access to one or more Humana plans, 73 percent will have access to a BCBS affiliated plan (including BCBS plans offered by Wellpoint), and 68 percent will have access to a United Healthcare plan (Exhibit 5; Table A5). The general availability of these firms’ products has not noticeably changed from 2013 to 2014. However, the similarities in BCBS offerings from 2013 to 2014 obscure a decline in availability of BCBS branded Wellpoint plans (declining from 88 plans to 55 plans between 2013 and 2014), which is mostly offset by the growth in plans offered by other BCBS affiliates (growing from 205 plans to 233 plans between 2013 and 2014).
Medicare Advantage Plans Medicare Supplement Plans Medigap Plans in California
Medicare Advantage plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Many of these plans offer prescription drug coverage and may include additional coverage, such as dental, hearing, and/or vision benefits. Since each plan can vary in cost and additional benefits covered, it’s important to choose the right one for your needs.