Senior Insurance Blog

A The Henry J. Kaiser Family Foundation released a report that provides an analysis of Medicare Advantage enrollment trends among HMOs, PPOs, and PFFS plans.  The report highlights that 11.1 million people were enrolled in private Medicare Advantage plans as of March 2010.  This is an increase from 10.5 million in March 2009.  The report showed that this increase took place despite a reduction of available plans throughout that same period. 

The report also found that three or fewer insurance companies dominate the Medicare Advantage market in every state except New York.  In 14 states, one company enrolls more than half of all Medicare Advantage customers.  Nationwide, both UnitedHealth Group and Humana Inc. control 33% of the total Medicare Advantage enrollment nationwide. 

For the full report follow this link: http://kff.org/medicare/upload/8080.pdf

Medicare Doc Pay Cuts Expected to be Delayed Today

Last night, the House of Representatives voted 417-1 to approve a Senate bill that delays a 21% cut in Medicare payments to doctors.  The bill delays the cuts another six months.  Lawmakers will work on a more permanent solution in that time, but if history is any indication, a permanent solution isn’t coming anytime soon.  Obama has expressed his approval of the bill and is planning to sign it into law today. 

The Medicare doc pay cut delay was a part of a larger bill that included unemployment benefit extensions and more aid to states.  When that bill was filibustered by Republicans, Democrats separated the Medicare doc pay cut delay into its own bill.  Now the hope is that the much more expensive, permanent solution can be passed after congressional elections in November.  The bill being signed today will increase payments to providers by 2.2% and will be paid for with a series of health care and pension changes.

Medicare and Medicaid Implements New Fraud Mapping Tool

The Centers for Medicare & Medicaid Services (CMS) implemented a new fraud mapping tool that will eventually be used throughout all government agencies.  The fraud mapping tool was developed by the Recovery Accountability and Transparency Board to collect massive amounts of information in real time, analyze the data for fraud trends, and then project possible fraud or errors using an array of indicators.  This new tool comes on top of the “Do Not Pay” list created last week.  Both methods aim to achieve President Obama’s goal of cutting improper Medicare payments in half by 2012.

Sentinel Life Medicare Supplement Plan N Approved in CA, IA, and LA

Sentinel Life Medicare Supplement Plan N has been approved for Louisiana, Iowa, and California.  Each of these plans offer competitive rates and generous commissions.  To learn more about these products click here.

Sources: AP, NPR, KFF, KHN

In another sign that Medicare Advantage is falling by the wayside, yesterday CIGNA announced it will not offer CIGNA Medicare Access (PFFS), its individual private fee-for-service medical plan, in 2011.  Customers of these plans will experience no change for this year.  CIGNA will continue to serve its clients, brokers, health care professionals, and contractors into 2011 for 2010 claims.  Now that CIGNA PFFS customers will need to choose a new medical coverage option for 2011, this presents a great opportunity to promote Medicare supplements to them, especially Medicare Supplement Plan N.

Medicare Checks Sent Out to Seniors
As posted on our Twitter feed earlier this week, the Obama administration started sending out $250 checks to seniors who fall into the Medicare prescription drug doughnut hole.  With elections looming on the horizon, Democrats are touting the checks as the first of many benefits to come from health care reform legislation signed into law earlier this year (PP&AC Act).   In some states, Democrats are buying air time to broadcast a 60-second television ad stating how Republicans promised to repeal the healthcare reform bill.  Democrats also sent boxes of “GOP Doughnut Holes” to various media outlets as a sign that the doughnut hole rebate benefit would not exist under GOP leadership.  Of course, as you may already know, in most cases, the $250 is only about 1/14 of the total $3,610 hole. 

Infection Control a Major Issue at Medicare ASCs
Earlier this week, the Journal of the American Medical Association published a new study from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS), that found 2/3 of ambulatory surgical centers (ASCs) in three states experienced infection control lapses.  CMS defines ACSs as facilities that operate exclusively to provide surgical services to patients who do not require hospitalization or stays in a surgical facility longer than 24 hours.  Roughly 70 ASCs that experienced the infection control lapses serve Medicare patients.  The lapses were typically found in process including hand washing, injection and medication safety, and equipment reprocessing.  To view a video overview of the report click here.

AMA Unleashes its Wrath on Congress for Neglecting Medicare
Due to a glitch with our e-mail system last week, many of you missed last week’s article.  To view that article, click here.

Reminder: Modernized Plan Approvals Info
We just wanted to provide you with a friendly reminder that we offer three methods for checking out the latest modernized plan approvals.   First, we post updates immediately to our Twitter feed, second we post the update to our approval chart, and third if a carrier’s plan is new to the state, we’ll add it to our product availability map.  When it comes to modernized plan info, at PSM we’ve got you covered.

Sources: Reuters, Politico, CNN, JAMA, NPR

You may have read on other blogs that the doctor fix is in, but it’s not. The House of Representatives voted last Friday on May 28 to freeze the scheduled Medicare payment cut until 2011, however the U.S. Senate failed to pass the bill before going on a week-long Memorial Day break.

The 21% Medicare payment cut took effect June 1, but the Centers for Medicare and Medicaid Services (CMS) ordered a temporary freeze on doctor payments, giving Congress time to retroactively approve the bill that freezes the cut.

In response the American Medical Association (AMA) launched a multi-million dollar series of advertisements that will appear in newspapers, radio, and television. The ads aim to pressure senators to pass the bill as soon as possible by criticizing them for taking a vacation while more than 40 million seniors and millions of health care providers are left worrying about the future of their healthcare and businesses respectively. The AMA also hopes to further its goal of getting the government to pass a permanent fix by changing the current Medicare payment formula. Such a fix would cost an estimated $250 billion over ten years, which is why the Senate continues to repeatedly delay the cuts rather than address the root cause of the problem.

Various news outlets, such as Reuters are reporting that some doctors are no longer taking new Medicare patients due to the volatility of the situation.

Ironically, the Medicare payment cut also impacts TRICARE (the health program for military families), as it utilizes the Medicare payment formula. Looks like our Senators celebrated Memorial Day a little too quickly.

The AMA has set up a web page titled "Medicare Payment Action Kit." You can view many different documents it has created on the whole issue. Check it out here.

Earlier this week, the Centers for Medicare and Medicaid Services (CMS) dispatched a four-page brochure to 40 million senior citizens that explains how the new health care law will affect the Medicare program. The content of the tax payer funded Medicare brochure has Republican politicians incensed and calling for an investigation by the Government Accountability Office (GAO).

Several Republican senators describe the Medicare brochure as misleading and a form of government propaganda constituting an illegal use of tax-payer funds. At the heart of the controversy are statements in the brochure that allegedly promise savings and increased quality health care. The brochure uses the words “improves” and “improvements” eight times, which imply the superiority of the reforms over the old system.

Republican politicians are still very skeptical about the impact of the health reform law, and view the claims made in the brochure as unsubstantiated, as no one can say for sure that the provisions of the reform law will result in an improvement. Republicans are saying the mailing was sent out as a tool ahead of mid-term elections to garner crucial votes from seniors. In addition to the GAO investigation, Republicans on the Ways and Means Committee are asking HHS Secretary Kathleen Sebelius to halt distribution of the brochure until the investigation is complete.

Ironically, this situation was reversed six years ago. According to NPR, during that time George W. Bush’s administration sent out correspondence with the aim of educating seniors about a new Medicare prescription drug law passed at the time with mostly Republican votes. Democrats were outraged and called for investigations by the GAO. The investigations led to findings that the mailings were “misleading” and that public money was essentially used to make fake news. Then and now, both administrations claim the need to inform seniors about crucial changes to the Medicare program as justification for the mailings.

View the Medicare brochure

Precision Senior Marketing wishes you a great holiday weekend filled with fun and relaxation. Our offices will be closed on Memorial day and resume normal operating hours on Tuesday, June 1. Should you have any urgent issues, e-mail info@psmbrokerage.com.

Sources: NPR, Politico, The Hill

 Kaiser Health News has an excellent article on how Medicare costs are increasing rapidly in traditionally low cost areas. The article focuses on the city of Provo, Utah where residents are among the healthiest in the country and its largest hospital is operated by Intermountain Healthcare, an organization praised by President Obama for providing high quality care at reasonable costs. Despite these factors, spending on Medicare patients has increased significantly in the last few years.

According to experts cited in the article, the major reason for this spike in spending is the use of expensive, new technologies, (such as the use of robotics for surgery) many of which are said to introduce little to no improvement over traditional methods. They go on to say that competition forces hospitals to adopt the latest technology, as patients always want the “best” care, which they equate to new technology. The new health care law is only going to exacerbate this problem. Now that reimbursement will be tied to quality health care, not only will hospitals be pressured to use the latest tools and techniques, but they most likely will extend patient stays, and use more aggressive (and expensive) treatments at earlier stages of illnesses.

The article goes on to say that what is happening in Provo, Utah is also happening in other traditionally low cost areas of the nation. The biggest concern among experts in the field is that these spikes are indicative of what will happen throughout the country as more hospitals begin to focus on higher quality care for Medicare patients, just at a more severe level.

Medicare Reimbursements Per Enrollee Interactive Map

CMS Will Spend $73 million to Upgrade its Websites

CGI Federal Inc. was awarded a five-year, $73.2 million contract to upgrade and continue maintenance of Medcare.gov, cms.hhs.gov, and MyMedicare.gov.  Together these sites see 500 million page views each year and provide information to 44 million beneficiaries and millions of other health care providers.

Starting in the fall of 2011, the Annual Election Period (AEP) will take place beginning October 15 and run through December 7.  This is a change from the current schedule of November 15 to December 31.  

Then on January 1, 2011, the Open Enrollment Period (OEP) will be eliminated.  As many of you already know, this period allowed beneficiaries to switch between “like” plans from January 1 to March 31 each year.

Also in 2011, the first Baby Boomers start to age into Medicare. There are 45 million Medicare eligibles in the country today, and by 2020 that number will grow to over 60 million. If you have any questions regarding these changes, please call us at 1-800-998-7715 or e-mail to info@psmbrokerage.com.

Source: Bravo Health

According to Mark Farrah Associates, a healthcare data aggregator and publisher, the number of newer policies issued over the last three years increased by 1.25% in 2009 when compared to the 2008 base. MFA reports that this continued growth of the Med Supp market is an encouraging sign for Medigap-based organizations looking to capitalize on the new modernized plans taking effect June 1, 2010.

The MFA article also provides other updated Med Supp information from 2009, such as breakdowns of Plan popularity (Plan F still rules), number of carries and plans, premium and claim amount comparisons, and overall carrier market share. Click here to view the article in its entirety.

Many Seniors not in the Best Medicare Advantage Plans

A study released by Avalere Health, a major consulting firm, reports that 47% of seniors on Medicare are in MA plans that rate three or two stars on Medicare’s quality rating scale. Three stars equal medium quality, and two stars equal fair quality. Also, only 23% of seniors on Medicare were enrolled in four to five star rated plans. According to Avalere, these quality ratings will become much more important due to the new health care law passed, as Medicare payments will now be tied to quality. More specifically, beginning in 2012, the new health care law mandates Medicare to award bonuses to four star or better plans. Click here for the full article.

Independent Payment Advisory Board (IPAB) to Cap Medicare Spending

James Capretta of the Ethics and Public Policy Center says “Medicare spending is now officially capped.” He points out that the IPAB, a 15-member independent panel appointed by the president and confirmed by the Senate, is responsible for enforcing an upper limit on annual Medicare spending growth. Mr. Capretta goes on to give a good, thought-provoking assessment of the impact the IPAB will have on the Medicare market.

He is generally against using payment cuts as a way of addressing Medicare’s rising costs stating “Certainly, more of the same payment rate reductions will not do it. Medicare’s chief actuary has already said that the payment cuts in the health reform law are unsustainable because they don’t change the cost structure for those providing care. In a very real sense, seniors will be the ones holding the bag from these cuts when they can’t access care due to a lack of willing suppliers.” Read the full article here.

Noam Levey of the Tribune Washington Bureau is reporting that the recent health reform laws signed into law by President Obama may lead to lower Medicare premiums for our nation’s senior citizens. His report is based on last night’s issuance of an analysis on the new health legislation by independent actuaries at the U.S. Department of Health and Human Services. The analysis is highly regarded as it is seen as the first comprehensive look at the legislation by neutral experts.

Mr. Levey says that the report suggests that the Medicare program will remain solvent until 2029 – better than estimates prior to health care reform which had projected that the program would be doused in red ink around 2017. And according to a statement issued by HHS Secretary Kathleen Sebelius Medicare monthly premiums will be lower than otherwise expected due to several measures in the bill, such as Medicare cuts, higher taxes, and a commission responsible for Medicare savings.

Of course not all is rosy with the analysis of the legislation. Fox News’ report on the analysis states that the bill will raise projected spending by about 1% over 10 years, and could be even larger since the analysis warned that Medicare cuts in the law may be unrealistic and unsustainable. The analysis also projected that Medicare cuts could result in sending 15% of hospitals and other Medicare providers into the red, thereby reducing access to seniors.

The report also estimated that a large exodus from Medicare Advantage would occur due to reductions in payments to private Medicare Advantage plans that would eliminate many of the extra benefits currently offered. The analysis projects that Medicare Advantage enrollment will decrease by 50%. This would leave seniors to seek out alternatives such as Medicare supplements, or be saddled with larger out-of-pocket expenses.

Sources: HHS, Los Angeles Times, Fox News