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Mutual of Omaha: Medicare Solutions Product Portfolio

Posted by www.psmbrokerage.com Admin on Wed, Jun 12, 2019 @ 01:04 PM


As people approach age 65, they’re bombarded with insurance offers. While some companies continue to add to the clutter and confusion, Mutual of Omaha is focused on helping you guide your clients through the complexity of selecting Medicare coverage. So, when they turn to you for help, turn to Mutual of Omaha’s Medicare Solutions portfolio.

Medicare-age clients are looking to stay physically and financially healthy. Considering they need to make their savings last, they want to know what’s covered and how much things will cost. They want to feel confident that the coverages they choose will help protect their health and budget.

Mutual of Omaha’s Medicare Solutions can do just that.

Take a look at their products that help solve your clients’ needs during their retirement years:

  • Medicare Supplement Insurance. Competitive pricing, premium savers and fast policy issue
  • Dental Insurance. Guaranteed issue, two plans available (both with optional vision rider), backed by a network of about 375,000 provider locations
  • Mutual of Omaha Rx. Two national prescription drug plans with affordable premiums, Value plan has $0 deductible for Tiers 1 & 2 prescriptions
  • Cancer, Heart Attack/Stroke Insurance. Limited underwriting, direct payment upon diagnosis, policies up to $100,000

Mutual of Omaha’s great senior product offerings and unparalleled service are the perfect complement to your clients’ needs.

If you have questions or would like to get contracted, please call us at (800) 998-7715 or complete our online request form.

Mutual of Omaha Rx (PDP) is a prescription drug plan with a Medicare contract. Enrollment in the Mutual of Omaha Rx plan depends on contract renewal.

Additional Updates:
 

Tags: Medicare Supplement, Medicare Part D, Mutual of Omaha Medicare Supplement, dental plans, MACRA

Benefit Chart of Medicare Supplement Plans Sold on or after January 1, 2020

Posted by www.psmbrokerage.com Admin on Wed, Jun 12, 2019 @ 08:32 AM

BENEFIT CHART OF MEDICARE SUPPLEMENT PLANS SOLD ON OR AFTER JANUARY 1, 2020


With MACRA right around the corner, this chart should be helpful if you are currently selling Medicare Supplement plans.

Here is a link to the PDF document.


2020 med supp benefits

Source

Image: www.Canva.com

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Tags: Medicare Supplement, MACRA

The 10 Time Management Strategies You Need to Implement Now

Posted by www.psmbrokerage.com Admin on Wed, Jun 12, 2019 @ 08:14 AM

The 10 Time Management Strategies You Need to Implement Now


June 11, 2019 by Anthony Iannarino

Here are ten strategies that, when implemented, are guaranteed to improve your productivity.

  1. Calibrate Your Priorities: There is nothing more critical to effective time management than determining your priorities. If you are going to be productive with time, you need to know what you want in every area of your life, something I call Achievement by Design. Because you have one life, you should design what you want from it. It’s too easy to get wrapped up in tasks that are not related to your priorities, so get clear on what’s most important first.

  2. Determine Your Outcomes: One of the reasons so many people struggle with time management is that they have a task list, or a to-do list if you like that better. The most productive people have these lists too, but they are focused on the outcomes of the tasks, not the tasks themselves. Let’s say you want to increase the sales of your business by $1,000,000. That growth will likely require many to-dos, and those tasks will probably change over time. Let me give you a straightforward example. You might have a task that reads, “Go to dinner with significant other.” The outcome might be “deepen the relationship with significant other,” a result you can achieve regardless of where you eat dinner.

  3. Treat Everything Like a Project: One way to improve your time management is to treat everything as a project. A project will likely have several tasks, it will take some time, and you will probably have helpful resources available to you. When you treat important outcomes as a project, you spend time planning your actions, and you schedule a time to complete the necessary tasks, turning a list of tasks into something more substantial.

  4. Establish Routines: In interviewing dozens of writers, they universally shared the routine of rising very early and producing pages first thing in the morning. They all suggest this routine was an essential part of their process. Whether your routine is to work immediately upon waking (my method) or go for a run or a workout, the discipline will improve your time management. You might have a morning routine, an afternoon routine, a weekly review routine, or a routine for reviewing your priorities.

  5. Draw Boundaries: When you say “yes” to small things, you are saying “no” to bigger things. It is challenging to manage your time when you don’t have boundaries. Some people want your time and attention at work, and many times, their needs are real. Without borders, you will never be able to protect the time you need for your priorities. You will no doubt be asked to help with projects, some of which will be interesting to you. However, when you agree to chair a committee, you are saying no to the things that are more important to you. Saying “no” is a powerful and necessary strategy, if you want to manage your time better.

  6. Schedule Weeks and Days: Minutes turn into hours, hours into days, days into weeks, and weeks into months. It is easy to fritter away your time when you haven’t determined beforehand what you are going to do with it. Once you know your priorities, you can schedule your days and weeks, starting each day with a solid plan to make progress on the few important things. When you begin to work, you won’t waste any time deciding what you need to do.

  7. Give Your Priorities Your Focus: Even though you have a schedule, you have limited attention and focus. You have some times of the day where your focus and your will power is stronger (for me, it is the first thing in the morning). You want to give your best energy to your most important priorities. Refuse to give those power hours to things like your email or social media sites. Instead, do the few things that move you closer to the outcomes you need to produce.

  8. Aggregate Tasks: Some tasks are necessary, like responding to your email or voice mail. You also have to pay your bills and fill out reports. These tasks lend themselves to aggregation. Instead of living in your inbox, check it three times a day, and process the emails completely (if you read it, decide what to do with it, do it, or put it on a task list, then archive it). If you are going to pay your bills or do your expense reports, collect them and do all of this work in one sitting—instead of allowing it to chip away at your time.

  9. Use a Single Task Manager: Some people’s idea of a task manager is a computer monitor covered in yellow post-it notes (maybe not the most elegant solution, and one that is also not mobile-friendly). It would be best if you had all of your projects and tasks wrangled into one place where you are confident you won’t miss something. If you like electronic task managers, there are dozens of good ones. If you prefer analog, a notebook works, as long as you keep everything there. Whatever your choice, commit to it completely.

  10. Decide What Not to Do: A to-don’t list is as crucial as a task list. What would go on a to-don’t list? How about “Don’t open email first thing in the morning.” Or, “Don’t allow people to interrupt your focus blocks.” If you want to do even better with your time, maybe try: “Don’t let other people place their priorities above mine,” knowing you can make exceptions when it makes sense. A list of things you are not willing to do will help you better manage your time.

Source: https://thesalesblog.com/2019/06/11/the-10-time-management-strategies-you-need-to-implement-now/

Image: www.Canva.com

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Tags: Sales Tips, Time Management

The largest Medicare Advantage insurers in each state

Posted by www.psmbrokerage.com Admin on Tue, Jun 11, 2019 @ 02:34 PM

The largest Medicare Advantage insurers in each state


Here are the largest Medicare Advantage plans by number of covered lives in each state, according to a report from America's Health Insurance Plans.

Alabama: Blue Cross and Blue Shield of Alabama, Cigna, Humana, UnitedHealthcare, Viva Health

Alaska: Aetna, Humana, UnitedHealthcare

Arizona: Blue Cross and Blue Shield of Arizona, Centene, Cigna, Humana, UnitedHealthcare

Arkansas: Aetna, Humana, UnitedHealthcare, USAble Mutual, WellCare

California: Blue Shield of California, Centene, Kaiser Permanente, SCAN Health Plan, UnitedHealthcare

Colorado: Aetna, Denver Health Medical Plan, Humana, Kaiser Permanente, UnitedHealthcare

Connecticut: Aetna, Anthem, EmblemHealth, UnitedHealthcare, WellCare

Delaware: Aetna, Cigna, Horizon Blue Cross and Blue Shield of New Jersey, Humana, UnitedHealthcare

Florida: Aetna, Anthem, Florida Blue, Humana, UnitedHealthcare

Georgia: Aetna, Humana, Kaiser Permanente, UnitedHealthcare, WellCare

Hawaii: HMSA, Humana, Kaiser Permanente, UnitedHealthcare, WellCare

Idaho: Blue Cross of Idaho, PacificSource, Regence BlueShield, SelectHealth, UnitedHealthcare

Illinois: Aetna, Health Alliance Medical Plans, Health Care Service Corporation (HCSC), Humana, UnitedHealthcare

Indiana: Aetna, Anthem, Blue Cross Blue Shield of Michigan, Humana, UnitedHealthcare

Iowa: Aetna, Health Alliance Medical Plans, HealthPartners UnityPoint Health, Humana, UnitedHealthcare

Kansas: Aetna, Blue Cross and Blue Shield of Kansas City, Highmark, Humana, UnitedHealthcare

Kentucky: Aetna, Anthem, Humana, UnitedHealthcare, WellCare

Louisiana: Humana, Peoples Health, UnitedHealthcare, Vantage Health Plan, WellCare

Maine: Aetna, Humana, Martin's Point Health Care, UnitedHealthcare, WellCare

Maryland: Aetna, Cigna, Johns Hopkins Healthcare, UnitedHealthcare, University of Maryland Health Advantage

Massachusetts: Blue Cross Blue Shield of Massachusetts, Fallon Health, Magellan Health, Tufts Health Plan, UnitedHealthcare

Michigan: Blue Cross and Blue Shield of Michigan, Health Alliance Plan (HAP), Humana, Priority Health, UnitedHealthcare

Minnesota: Blue Cross and Blue Shield of Minnesota, HealthPartners, Humana, Medica, UCare

Mississippi: Aetna, Cigna, Humana, UnitedHealthcare, WellCare

Missouri: Aetna, Anthem, Essence, Humana, UnitedHealthcare

Montana: Aetna, Health Care Service Corporation (HCSC), Humana, PacificSource, UnitedHealthcare

Nebraska: Aetna, Blue Cross and Blue Shield of Nebraska, Highmark, Humana, UnitedHealthcare

Nevada: Aetna, Anthem, Hometown Health Plan, Humana, UnitedHealthcare

New Hampshire: Anthem, Harvard Pilgrim Health Care, Humana, Martin's Point Health Care, UnitedHealthcare

New Jersey: Aetna, Anthem, Clover Health, Horizon Blue Cross and Blue Shield of New Jersey, UnitedHealthcare

New Mexico: Health Care Service Corporation (HCSC), Humana, Molina Healthcare, Presbyterian Health Plan, UnitedHealthcare

New York: Aetna, EmblemHealth, Excellus BlueCross BlueShield, Healthfirst, UnitedHealthcare

North Carolina: Aetna, BlueCross BlueShield of North Carolina, Care N' Care, Humana, UnitedHealthcare

North Dakota: Aetna, Great Plains Medicare Advantage, Health Care Service Corporation (HCSC), Humana, UnitedHealthcare

Ohio: Aetna, Anthem, Humana, Mount Carmel Health Plan, UnitedHealthcare

Oklahoma: Aetna, CommunityCare, GlobalHealth, Humana, UnitedHealthcare

Oregon: Centene, Kaiser Permanente, Providence Health Plan, Regence BlueCross BlueShield, UnitedHealthcare

Pennsylvania: Aetna, Geisinger Health Plan, Highmark, Independence Blue Cross, UPMC Health Plan

Rhode Island: Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Magellan Health, UnitedHealthcare

South Carolina: Aetna, Cigna, Humana, UnitedHealthcare, WellCare

South Dakota: Aetna, Blue Cross and Blue Shield of Michigan, Great Plains Medicare Advantage, Humana, UnitedHealthcare

Tennessee: Anthem, BlueCross BlueShield of Tennessee, Cigna, Humana, UnitedHealthcare

Texas: Aetna, Cigna, Humana, UnitedHealthcare, WellCare

Utah: Aetna, Molina Healthcare, Regence BlueCross BlueShield, SelectHealth, UnitedHealthcare

Vermont: Aetna, Anthem, Horizon Blue Cross and Blue Shield of New Jersey, MVP Health Care, UnitedHealthcare

Virginia: Aetna, Anthem, Humana, Piedmont Community Health Plan, UnitedHealthcare

Washington: Humana, Kaiser Permanente, Premera BlueCross, Regence BlueShield, UnitedHealthcare

Washington, D.C.: Aetna, Cigna, Kaiser Permanente, MedStar Medicare Choice (as of Jan. 1, 2019, no longer offers Medicare Advantage), UnitedHealthcare

West Virginia: Aetna, Highmark, Humana, The Health Plan, UnitedHealthcare

Wisconsin: Gundersen Health Plan (Quartz), Humana, Network Health, Security Health Plan of Wisconsin, UnitedHealthcare

Wyoming: Aetna, Humana, UnitedHealthcare

Source: https://www.beckershospitalreview.com/payer-issues/the-largest-medicare-advantage-insurers-in-each-state.html

Image: www.Canva.com

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Tags: Medicare Advantage

Prescription Costs Doubled in Last 8 Years

Posted by www.psmbrokerage.com Admin on Tue, Jun 11, 2019 @ 02:08 PM


By Marlene Satter – BenefitsPro – June 10, 2019

According to the JAMA Network Open, between January 2012 and December  2017, prices for 48 out of 49 of the most common brand-name prescription drugs rose. In fact, 78% of the drugs available since 2012 saw an increase in insurer and out-of-pocket costs by more than 50%, and 44% more than doubled in price. MarketWatch reports the median price increases hit 76% over the six years, and some drugs didn’t just have one price increase per year but two. The number of adults over 65 – a growing demographic that takes about a third of all prescription drugs – is going to outnumber the under-18 demographic by 2035, and will have a significant impact on spending.

Source: https://www.benefitspro.com/2019/06/07/brand-name-prescription-drug-prices-double-in-6-to-8-years/?slreturn=20190511150621

Image: www.Canva.com

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Tags: Prescription Drugs

Save the date: 2020 Aetna producer certification begins July 10th

Posted by www.psmbrokerage.com Admin on Tue, Jun 11, 2019 @ 01:56 PM


The producer certification process for 2020 Aetna Medicare MA/MAPD products kicks off on July 10th. Certification is one of the annual requirements you must complete to sell Aetna 2020 plans during AEP. Their 2020 producer certification includes AHIP, plus several Aetna-specific training modules, and costs only $125 (retail prices is $175).
 
So even though AHIP plans to release their 2020 courses on June 17, we encourage you to wait and complete AHIP through Aetna's certification process starting July 10. It’s an easy way to save $50.

Link to certification will be available here when launched on July 10th.

Image: www.Canva.com

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Tags: Medicare Advantage, Medicare, aetna

What Percent of New Medicare Beneficiaries Are Enrolling in Medicare Advantage?

Posted by www.psmbrokerage.com Admin on Mon, Jun 10, 2019 @ 05:04 PM


People new to Medicare can receive their Medicare benefits through either traditional Medicare or private plans, such as HMOs or PPOs, known as Medicare Advantage plans. Older adults and younger beneficiaries with disabilities have said that they make this choice based on premiums and out-of-pocket costs, access to desired providers, the reputation of the company offering the plan, ads and other marketing materials, and the advice of brokers, family members and friends. Medicare Advantage offers one-stop shopping, with all Medicare benefits in one combined package, and enrollees may have lower out-of-pocket costs than those in traditional Medicare, with an out-of-pocket cap and coverage of some additional benefits, such as eyeglasses. Beneficiaries in traditional Medicare have open access to providers and fewer administrative hassles, such as prior authorization and referral requirements.

One line of thinking has been that the Baby Boom Generation will enroll in Medicare Advantage plans over traditional Medicare at much higher rates than prior generations because they have had more experience with managed care during their working years. Our prior analysis found that, in 2011, nearly one in four people enrolled in Medicare Advantage plans during their first year on Medicare. This brief examines whether the rate has increased with more boomers aging onto Medicare, and whether these coverage decisions vary by geographic area and select characteristics. The analysis is based on a five percent sample of claims from 2010 to 2016.

Enrollment Rates

In 2016, Less than one-third (29 percent) of new beneficiaries enrolled in Medicare Advantage plans during their first year on Medicare, slightly more than the 23 percent observed in 2011, but far from a majority (Figure 1). Most new beneficiaries (71 percent) were covered under traditional Medicare for their first year on Medicare.

Read the full report


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Tags: Medicare Advantage, Medicare

Payment Glitch Interrupts Automatic Medicare Advantage and Part D Premium Withdrawals

Posted by www.psmbrokerage.com Admin on Mon, Jun 10, 2019 @ 04:35 PM

Payment Glitch Interrupts Automatic Medicare Advantage and Part D Premium Withdrawals


Earlier this year, a federal government systems issue prevented Medicare Advantage and Part D premiums from being automatically deducted from the Social Security payments of some people with Medicare. Normally, if a beneficiary elects, Social Security deducts the premiums and sends them directly to the plan. In this instance, the payments were not sent to the plans, and beneficiaries did not know that their plans were not receiving them.

While the issue has since been resolved and premium payments should be processed correctly moving forward, Medicare Rights remains concerned about the scope of the processing error and the potential impacts on beneficiaries—including confusion, financial hardship, and coverage losses.

According to the Centers for Medicare & Medicaid Services (CMS), affected individuals include those who were “enrolled either in a Medicare Advantage Plan or in a Medicare Prescription Drug Plan for coverage starting January 1, 2019” and chose to have their premiums automatically deducted from their monthly Social Security benefit, rather than pay the plan directly.

However, it’s not yet clear how many of these enrollees were affected, if those who were have been made aware, or how much they might owe. The Social Security Administration (SSA) notes that “Plans will be sending premium bills to those affected. If you are affected and haven’t already received a bill in the mail, you will soon. The first bill will likely be for a larger amount than usual to make up for the unpaid premiums.”

Importantly, plans must offer enrollees a “grace period” to repay the missed premium payments, which must last at least as long as the delay in billing. Plans also have the option not to pursue these outstanding payments.

CMS advises beneficiaries to call their plan directly with any questions or concerns. Medicare Rights’ Helpline counselors are also available at 800-333-4114, and enrollees may want to contact their local SHIP or 1-800-Medicare for assistance.

Medicare Rights appreciates federal agency and plan efforts to educate affected enrollees and we encourage them to continue to work together to hold beneficiaries harmless.

Read the CMS notice.

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Additional Updates:
 

Tags: Medicare Advantage, Medicare, Medicare Part D

12 Facts About Medicare Advantage in 2019

Posted by www.psmbrokerage.com Admin on Thu, Jun 06, 2019 @ 04:08 PM

12 Facts about Medicare Advantage

 

By the Kaiser Family Foundation – June 6 2019

Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. This data collection provides current information and trends about Medicare Advantage enrollment, premiums, and out-of-pocket limits. It also includes analyses of Medicare Advantage plans’ extra benefits and prior authorization requirements.

  1. Enrollment in Medicare Advantage has nearly doubled over the past decade

Figure 1: Total Medicare Advantage Enrollment, 1999-2019 (in millions)

9313-Figure-1

In 2019, one-third (34%) of all Medicare beneficiaries – 22 million people – are enrolled in Medicare Advantage plans, similar to the rate in 2017 and 2018. Between 2018 and 2019, total Medicare Advantage enrollment grew by about 1.6 million beneficiaries, or 8 percent – nearly the same growth rate as the prior year. The Congressional Budget Office (CBO) projects that the share of beneficiaries enrolled in Medicare Advantage plans will rise to about 47 percent by 2029.

  1. The share of Medicare beneficiaries in Medicare Advantage plans across the United States ranges from 1% to over 40%

Figure 2: Medicare Advantage Penetration, by State, 2019

9314-Figure-2

The share of Medicare beneficiaries in Medicare Advantage plans (including Medicare cost plans), varies across the country. In 28 states and Puerto Rico, at least 31 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, with more than 40 percent of enrollees in six states (HI, FL, MN, OR, WI, PA) and Puerto Rico. The majority of the Medicare private health plan enrollment in Minnesota has historically been in cost plans, rather than Medicare Advantage plans, but as of 2019, most cost plans in Minnesota are no longer offered and have been replaced with risk-based HMOs and PPOs. Medicare Advantage enrollment is relatively low (20 percent or lower) in 14 states and the District of Columbia, including two mostly rural states where it is virtually non-existent (AK and WY). 

  1. The share of Medicare beneficiaries in Medicare Advantage plans varies across counties from less than 1% to more than 60%

Figure 3: Medicare Advantage Penetration, by County, 2019

9314-Figure-3

Within states, Medicare Advantage penetration varies widely across counties. For example, in Florida, 66 percent of all beneficiaries living in Miami-Dade County are enrolled in Medicare Advantage plans whereas only 10 percent of beneficiaries living in Monroe County (Key West) do so. In 172 counties, accounting for 10 percent of the population, more than half of all Medicare beneficiaries are enrolled in Medicare Advantage plans or cost plans. Many of these counties are centered around large, urban areas, such as Monroe County, NY (66%), which includes Rochester, and Allegheny County, PA (61%), which includes Pittsburgh. In contrast, in 619 counties, accounting for 4 percent of Medicare beneficiaries, no more than 10 percent of beneficiaries are enrolled in Medicare private plans; many of these low penetration counties are in rural parts of the country but some urban areas, such as Baltimore City (17%), also have relatively low Medicare Advantage enrollment.

  1. 4. Most Medicare Advantage enrollees are in plans operated by UnitedHealthcare, Humana, or BlueCross BlueShield (BCBS) affiliates in 2019

Figure 4: Medicare Advantage Enrollment by Firm or Affiliate, 2019

9314-Figure-4

Medicare Advantage enrollment is highly concentrated among a small number of firms. UnitedHealthcare and Humana together account for 44 percent of all Medicare Advantage enrollees nationwide, and the BCBS affiliates (including Anthem BCBS plans) account for another 15 percent of enrollment in 2019. Another four firms (CVS/Aetna, Kaiser Permanente, Wellcare, and Cigna) account for another 22 percent of enrollment in 2019. For the third year in a row, enrollment in UnitedHealthcare’s plans grew more than any other firm, increasing by about 520,000 beneficiaries between March 2018 and March 2019. CVS purchased Aetna in 2018 and the combined company had the second largest growth in Medicare Advantage enrollment in 2019, increasing by also about 520,000 beneficiaries between March 2018 and March 2019.

  1. Half of Medicare Advantage enrollees pay no premium (other than the Part B premium) in 2019

Figure 5: Distribution of Medicare Advantage Enrollees, by Prescription Drug Plan Premium, 2019

9314-Figure-5

In 2019, 90% of Medicare Advantage plans offer prescription drug coverage (MA-PDs), and most Medicare Advantage enrollees (88%) are in plans that include this prescription drug coverage. More than half of these beneficiaries (56%) pay no premium for their plan, other than the Medicare Part B premium. However, 21 percent of beneficiaries in MA-PDs (3.0 million enrollees) pay at least $50 per month, including 7 percent who pay $100 or more per month, in addition to the monthly Part B premium ($135.50 in 2019). Among MA-PD enrollees who pay a premium for their plan, the average premium is $65 per month. All together, including those who do not pay a premium, the average MA-PD enrollee pays $29 per month in 2019.

  1. Premiums paid by Medicare Advantage enrollees have slowly declined since 2015

Figure 6: Average Monthly Medicare Advantage Prescription Drug Plan Premiums, Weighted by Plan Enrollment, 2010-2019

9314-Figure-6

Nationwide, average Medicare Advantage Prescription Drug (MA-PD) premiums declined by $5 per month between 2018 and 2019, much of which was due to the relatively sharp decline in premiums for local PPOs this past year, and since 2015. Average premiums for HMOs also declined $3 per month, while premiums for regional PPOs were relatively similar between 2018 and 2019. Average MA-PD premiums vary by plan type, ranging from $23 per month for HMO enrollees to $39 per month for local PPO enrollees and $44 per month for regional PPO enrollees. Nearly two-thirds (62%) of Medicare Advantage enrollees are in HMOs, 31% are in local PPOs, and 6% are in regional PPOs in 2019.

  1. For Medicare Advantage enrollees, the average out-of-pocket limit is $5,059 for in-network services and $8,649 for both in-network and out-of-network services (PPOs)

Figure 7: Average Medicare Advantage Plan Out-of-Pocket Limits, Weighted by Plan Enrollment, 2019

9314-Figure-7

In 2019, Medicare Advantage enrollees’ average out-of-pocket limit for in-network services is $5,059 (HMOs and PPOs) and $8,818 for out-of-network services (PPOs). For HMO enrollees, the average out-of-pocket (in network) limit is $4,706; these plans do not cover services received from out-of-network providers. For local and regional PPO enrollees, the average out-of-pocket limit for both in-network and out-of-network services are $8,796, and $8,901, respectively.

Since 2011, the Administration has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B not to exceed $6,700 (in-network) or $10,000 (in-network and out-of-network combined). Limits have been required for regional PPOs since 2006.

HMOs generally only cover the services provided by in-network providers, whereas PPOs also cover services delivered by out-of-network providers but charge enrollees higher cost-sharing for this care. The size of Medicare Advantage provider networks for physicians and hospitals vary greatly both across counties and across plans in the same county. 

 

  1. Most Medicare Advantage enrollees have access to some benefits not covered by traditional Medicare in 2019

Figure 8: Share of Medicare Advantage Enrollees in Plans with Extra Benefits by Benefit Type, 2019

9314-Figure-8

Medicare Advantage plans may provide extra benefits that are not offered in traditional Medicare, and can use rebate dollars to help cover the cost of extra benefits. Plans can also charge additional premiums for such benefits. Most enrollees are in plans that provide access to some dental care (67%), a fitness benefit (72%), and/or eye exams or glasses (78%). Since 2010, the share of enrollees in plans that provide some dental care or fitness benefits has increased (from 48% and 52% of enrollees, respectively) while the share with a vision benefit has been relatively steady (77% in 2010).

 

  1. Nearly four out of five Medicare Advantage enrollees are in plans that require prior authorization for some services

Figure 9: Share of Medicare Advantage Enrollees Required to Receive Prior Authorization, by Service, 2019

9314-Figure-9

Medicare Advantage plans can require enrollees to receive prior authorization before a service will be covered, and nearly four out of five Medicare Advantage enrollees (79%) are in plans that require prior authorization for some services in 2019. Prior authorization is most often required for relatively expensive services, such as inpatient hospital stays, skilled nursing facility stays, and Part B drugs, but infrequently required for preventive services. Beginning in 2019, Medicare Advantage plans can also require enrollees to use “step therapy” for Part B drugs, meaning that they are required to try some specific drugs (and fail to improve on those drugs) before they receive approval to try other drugs. In contrast to Medicare Advantage plans, traditional Medicare does not generally require prior authorization for services, and does not require step therapy for Part B drugs.

 

  1. The majority (72%) of Medicare Advantage enrollees are in plans that receive high quality ratings (4 or more stars) and related bonus payments

Figure 10: Distribution of Medicare Advantage Enrollees by Plan Star Rating, 2015-2019

9314-Figure-10

In 2019, more than two-thirds (72%) of Medicare Advantage enrollees are in plans with quality ratings of 4 or more stars, a decrease from 74 percent in 2018. An additional 2 percent of enrollees are in plans that were not rated because they were part of contracts that had too few enrollees or were too new to receive ratings. Plans with 4 or more stars and plans without ratings are eligible to receive bonus payments for each enrollee the following plan year (2020). The share of enrollees in plans with 2.5 stars (below average ratings) nearly doubled from 3 percent in 2018 to 6 percent (nearly 1 million people) in 2019.

For many years, the Centers for Medicare and Medicaid Services (CMS) has posted quality ratings of Medicare Advantage plans to provide beneficiaries with additional information about plans offered in their area. All plans are rated on a 1 to 5-star scale, with 1 star representing poor performance, 3 stars representing average performance, and 5 stars representing excellent performance. CMS assigns quality ratings at the contract level, rather than for each individual plan, meaning that each plan covered under the same contract receives the same quality rating (and most contracts cover multiple plans).

 

  1. One in five Medicare Advantage enrollees are in employer or union-sponsored group plans in 2019

Figure 11: Distribution of Medicare Advantage Enrollees, by Plan Type, 2019

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One in five Medicare Advantage enrollees (4.4 million) are in group plans offered by employers and unions for their retirees in 2019. Under these arrangements, employers or unions contract with an insurer and Medicare pays the insurer a fixed amount per enrollee to provide benefits covered by Medicare. The employer or union (and sometimes the retiree) may also pay a premium for additional benefits or lower cost-sharing. Group enrollees comprise a disproportionately large share of Medicare Advantage enrollees in ten states: Alaska (100%), West Virginia (50%), Michigan (49%), New Jersey (42%), Illinois (39%), Kentucky (38%), Wyoming (37%), Maryland (36%), Delaware (35%), and New Hampshire (33%).

 

  1. Nearly 3 million Medicare beneficiaries are enrolled in Special Needs Medicare Advantage Plans in 2019

Figure 12: Number of Beneficiaries in Special Needs Plans, 2006-2019 (in millions)

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Special Needs Plans (SNPs) restrict enrollment to specific types of beneficiaries with significant or relatively specialized care needs. The majority of SNP enrollees (85%) are in plans for beneficiaries dually eligible for Medicare and Medicaid (D-SNPs), with the remainder in plans for beneficiaries requiring a nursing home or institutional level of care (I-SNPs), or with severe chronic or disabling conditions (C-SNPs.)

Enrollment in SNPs increased modestly from 2.6 million beneficiaries in 2018 to 2.9 million beneficiaries in 2019, accounting for about 13 percent of total Medicare Advantage enrollment in 2019, with some variation across states. In seven states, the District of Columbia, and Puerto Rico, enrollment in SNPs comprises at least one-fifth of Medicare Advantage enrollment (51% in DC, 49% in PR, 25% in SC, 22% in NY, 21% in AR, 20% in AZ, 20% in FL, 20% in GA, and 20% in TN). Most C-SNPs enrollees (93%) are in plans for people with diabetes or cardiovascular disorders in 2019. Enrollment in I-SNPs has been increasing, but is still less than 100,000 beneficiaries.

Source: http://files.kff.org/attachment/Data-Note-A-Dozen-Facts-About-Medicare-Advantage-in-2019

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Tags: Medicare Advantage

Looming Crisis: Rising Demand for LTC

Posted by www.psmbrokerage.com Admin on Wed, Jun 05, 2019 @ 02:30 PM

Looming Crisis - Rising Demand for LTC

 
By Steven Johnson – ModernHealthCare – June 4, 2019

An estimated 69% of Americans will require long-term care services at some point in their lives, for an average of about three years, according to HHS. About 13% of adults pay for their care out-of-pocket, which will become more difficult to sustain due to the financial burden, says a new study by Health Affairs. For those with significant long-term support and services, their median amount of wealth would only allow for long-term home care for about 16 months at an average cost of $1,170 for 90 hours of home care a month.

REPORT

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Tags: long term care

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