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Medicare Advantage Will Soon Have Even More Advantages

Posted by www.psmbrokerage.com Admin on Wed, Apr 25, 2018 @ 01:14 PM

Medicare Advantage Will Soon Have Even
More Advantages

Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage when new federal rules take effect next year.Medicare Advantage Will Soon Have Even More Advantages

The Centers for Medicare & Medicaid Services expanded how it defines the "primarily health-related" benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.

"Medicare Advantage beneficiaries will have more supplemental benefits, making it easier for them to lead healthier, more independent lives," said CMS Administrator Seema Verma.

Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits.

Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. In addition to transportation to doctors' offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries' homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs.

"This will allow us to build off the existing benefits that we already have in place that are focused more on prevention of avoidable injuries or exacerbation of existing health conditions," said Alicia Kelley, director of Medicare sales for Capital District Physicians' Health Plan, a nonprofit serving 43,000 members in 24 upstate New York counties.

Even though a physician's order or prescription is not necessary, the new benefits must be "medically appropriate" and recommended by a licensed health care provider, according to the new rules.

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

UnitedHealthcare, the largest health insurer in the US, also welcomes the opportunity to expand benefits, said Matt Burns, a company spokesman. "Medicare benefits should not be one-size-fits-all, and continued rate stability and greater benefit design flexibility enable health plans to provide a more personalized health care experience," he said.

But patient advocates including David Lipschutz. Senior policy attorney at the Center for Medicare Advocacy, are concerned about those who may be left behind.

"It's great for the people in Medicare Advantage plans, but what about the majority of the people who are in traditional Medicare?" he asked. "As we tip the scales more in favor of Medicare Advantage, it's to the detriment of people in traditional Medicare."

The details of the 2019 Medicare Advantage benefit packages must first be approved by CMS and will be released in the fall, when the annual open enrollment begins. It's very likely that all new benefits will not be available to all beneficiaries since there is "tremendous variation across the country" in what plans offer, said Gretchen Jacobson, associate director of the Kaiser Family Foundation's Program on Medicare Policy.


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Tags: Medicare Advantage plans, medicare updates

Medicare Advantage expected to grow to 50% of market, says UnitedHealth Group

Posted by www.psmbrokerage.com Admin on Wed, Apr 18, 2018 @ 04:26 PM

Medicare Advantage expected to grow to 50% of the market, says UnitedHealth Group

UnitedHealth Group reported first quarter earnings from operations growth of 18.8 percent year-over-year, driven by a strong performance in the Medicare Advantage and Medicaid markets as well as double-digit percent increases in its Optum segments.

Medicare Advantage expected to grow to 50 of market, says UnitedHealth Group

UnitedHealth Group reported $4.1 billion in Q1 earnings from compared to $3.4 billion for the three months ended March 31, 2017. First quarter net earnings grew by 28.7 percent over the previous year.

Based on first quarter results and the business outlook for the balance of the year, UnitedHealth Group has increased its outlook for 2018 net earnings.

UnitedHealth Group looks very different from five years ago, said CEO David S. Wichmann during Tuesday's earnings call. Today clinical and technical professions are the first and third largest job categories across UnitedHealth Group. Five years from now the company will also be different.

"Within 10 years, we expect half of all Americans will be receiving their healthcare from physicians operating in highly evolved and coordinated value-based care designs," Wichmann said.

UnitedHealthcare, the company's insurance arm, reported earnings from operations for the quarter of $2.4 billion, compared to $2.1 billion the year before, a 12.5 percent increase.

The insurer serves 2.2 million more consumers quarter-over- quarter, but as forecasted, the employer and individual market served 195,000 fewer people in commercial group plans.

This was due to employers shifting their retirees from self-funded offerings to group Medicare Advantage plans and lower retention due to pricing to cover the full cost of the health insurance tax.

The Medicare Advantage and Medicaid markets are growing. UnitedHealthcare grew to serve 375,000 more seniors with medical benefits during the first 90 days of this year, including 330,000 more in Medicare Advantage, according to Steve Nelson, CEO of UnitedHealthcare.

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Medicare Advantage enrollment grew 10.6 percent year-over-year.

The Medicare Advantage market has always been competitive, said Brian Thompson, CEO for UnitedHealthcare Medicare & Retirement, to a question on other insurers jumping into the space.

But the Medicare Advantage market is also under-penetrated, he said. It has 33 percent of senior citizens in plans today, but the company sees a path to over 50 percent in the next 5-10 years, he said.

"In Medicaid we continue to expect strong revenue growth in 2018, and that includes ongoing national growth serving dual special needs members, providing them aligned benefits and comprehensive service to address their often times more complex care needs," Nelson said.

The insurer closed gaps in care through simple preventative measures such as flu vaccines, to serving more complex needs. The social determinants of health such as lack of affordable housing, food insecurity and isolation weigh heavily on gaps in care.

Social investments are the next frontier to serving the whole person, executives said.


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Tags: Medicare Advantage plans, medicare updates

CMS Gives Medicare Advantage a Raise

Posted by www.psmbrokerage.com Admin on Wed, Apr 04, 2018 @ 02:58 PM

CMS Gives Medicare Advantage Plans a Raise

The CMS finalized a rule Monday giving Medicare Advantage plans a 3.4% pay hike in 2019. That's well above the 1.84% bump the agency initially proposed and higher than the 2.95% increase for 2018.CMS gives Medicare Advantage plans a raise

The CMS is also moving forward with plans to increase the use of encounter data to determine risk scores for plans. As a result of the finalized rule, 75% of Medicare Advantage risk scores will be based on traditional fee-for-service data, and 25% based on encounter data. That differs from 2018, when the agency used a risk score blend of 85% fee-for-service data and 15% encounter data.

Stakeholders such as the American Hospital Association have pushed back at using encounter data after a January 2017 Government Accountability Office report found such information often isn't accurate.

"Since the quality of the encounter data has improved, CMS believes it is appropriate to move forward with the proposed increased percentage of encounter data in the blend," the agency said in a release Monday.

The CMS also finalized a policy to prevent Medicare beneficiaries who are deemed at risk for opioid misuse or abuse from obtaining prescription drugs from multiple doctors or pharmacies. Instead, they'll be locked into one pharmacy or prescriber for Medicare Part D benefits.

This lock-in will limit an at-risk beneficiary's access to coverage for frequently abused drugs to those that are prescribed by a specified pharmacy or provider.

Medicare Advantage enrollment is projected to grow by 9% to 20.4 million in 2018. The CMS estimated that more than one-third of all Medicare enrollees, or 34%, will be in a Medicare Advantage plan in 2018.

Source: http://www.modernhealthcare.com/article/20180402/NEWS/180409987/cms-gives-medicare-advantage-plans-a-raise

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Tags: Medicare Advantage plans, medicare updates

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