The CMS’s recent announcement of increased flexibility for Medicare Advantage plans to offer supplemental benefits (benefits not covered under Parts A or B) are complicated. Beginning in 2020, M/A plans may offer chronically ill enrollees supplemental benefits not necessarily health-related but reasonably expected to improve or maintain health and function. CMS provided the following examples of supplemental benefits that would qualify as primarily health related:
These changes are incorporated into the 2020 Medicare Advantage and Part D Rate Announcement and Final Call Letter. Your supervisors will provide details and elaboration of new M/A plans’ benefits as the evolution of plans’ components continues.
Medicare Blog | Medicare News | Medicare Information
A number of Democratic proposals call for eliminating private health insurance and replacing it with a universal Medicare plan, claiming it would help reduce administrative inefficiencies in the health-care system. Most recently, Sen. Bernie Sanders of Vermont unveiled a bill that would create a government-run system to provide health insurance for all Americans. Freshman Rep. Alexandria Ocasio-Cortez is pushing a similar plan.
Wichmann, who rarely discusses politics, told investors on a post-earnings conference call Tuesday such measures would "surely jeopardize the relationship people have with their doctors, destabilize the nation's health system and limit the ability of clinicians to practice medicine at their best."
"And the inherent cost burden would surely have a severe impact on the economy and jobs — all without fundamentally increasing access to care," he added.
The executive noted that health costs have grown less quickly than overall inflation for 16-straight months, saying "it has lessened considerably due to better management of price inflation and earlier and more effective management of care in lower cost settings."
Despite concerns from UnitedHealth, public support for a single-payer system has grown. According to a survey from the Kaiser Family Foundation last month, 56% of respondents supported a national health plan in which all Americans would get insurance from a single government plan, versus 39% who said they oppose it.
Health care has been the worst-performing sector in the stock market this year, rising by just 4.17% as of Monday's close, significantly lagging the broader market indexes. The Dow Jones Industrial Average is up 13.35% over the same period, and the S&P 500 is 16.12% higher.
The biggest decliners have been from insurers, which are under threat from "Medicare for All" proposals. Investors are also watching the Trump administration's legal challenge to former President Barack Obama's signature health insurance law, the Affordable Care Act.
A federal appeals court in New Orleans said last week that it will hear arguments in July on a lawsuit backed by President Donald Trump to overturn Obamacare. Dismantling the health-care law would lead to 32 million more uninsured people in the U.S. by 2026, according to an estimate from the Congressional Budget Office.
Earlier Tuesday, UnitedHealth reported first-quarter earnings and revenue that beat Wall Street's expectations. It was driven by strength in its pharmacy benefit management business and higher enrollment for its health plans.
The industry bellwether, which is the first health insurer to report quarterly results, also raised its full-year adjusted earnings forecast to between $14.50 and $14.75 per share from its prior projection of $14.40 to $14.70 a share.
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The 2020 payment updates will increase competition among Medicare Advantage and Part D health plans
By Jessica Kent – HealthPayerIntelligence – April 9, 21019
CMS finalized new Medicare Advantage and Part D payment policies for 2020 that will increase competition among health plans, leading to higher quality care at lower costs.
The changes will increase plan choices and benefits, enabling seniors to choose Medicare Advantage plans that are offering supplemental benefits tailored to their specific needs. The updated policies will also give chronically ill patients with Medicare Advantage the option of accessing a range of benefits that aren’t necessarily health-related, but can improve or maintain the overall health of beneficiaries.
These benefits may address the social determinants of health for beneficiaries with a chronic disease. For example, more Medicare Advantage enrollees may now receive meal delivery, transportation for non-medical needs like grocery shopping, and home environment services.
For beneficiaries with asthma, a Medicare Advantage plan could cover home air cleaners or carpet shampooing to reduce irritants that cause asthma attacks. Plans could also cover healthy food or produce for enrollees with heart disease, or education programs for those with diabetes.
“Today’s changes give plans the ability to be innovative and offering benefits and services that address social determinants of health for people with chronic disease,” said CMS Administrator Seema Verma. “With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that they focus on preventing disease and keeping people healthy.”
The new policy updates will also include actions to help curb the opioid epidemic. Medicare Advantage plans can now offer targeted supplemental benefits to beneficiaries, as well as cost sharing reductions for patients with chronic pain. With the new policies, CMS is also encouraging Part D plans to offer at least one opioid-reversal agent on a lower cost-sharing tier.
CMS’s past efforts to reduce opioid use have had positive results. The agency reports that between 2010 and 2017, its overutilization policies have led to a 14 percent decrease in the share of Part D beneficiaries using opioids.
CMS first proposed these policy changes in January 2019, aiming to expand coverage opportunities for beneficiaries.
“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” Verma said at the time.
“Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”
The new updates will expand on last year’s Medicare Advantage and Part D policy changes. Released in April 2018, these policy changes expanded the health-related benefits Medicare Advantage plans could offer, with benefits mainly supporting the daily maintenance of health.
Because of these changes, Medicare Advantage plans can now offer supplemental benefits that aren’t covered under Parts A and B, if these benefits compensate for physical impairments, diminish the impact of injuries or health conditions, or reduce avoidable emergency room utilizations.
The 2020 policy changes will enable Medicare Advantage plans to tailor benefits to suit beneficiaries’ needs and combat the opioid crisis, which will become increasingly important as Medicare Advantage and Part D plan enrollment continues to grow.
“Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. Average Medicare Advantage premiums are at their lowest in
six years, Part D premiums are at their lowest in three years, and plan choices have increased,” CMS concluded.
“Today’s announcement builds in additional flexibilities that will continue to increase choice and competition among Medicare health and drug plans.”
Access to telehealth services for seniors got another boost Friday when the Centers for Medicare & Medicaid Services said it would allow private Medicare Advantage plans to offer additional access to virtual doctors in their basic benefit packages.
The so-called final rule will bring new benefits to seniors in 2020 as part of their Medicare Advantage plans. Such coverage is growing rapidly and expected to account for half of Medicare beneficiaries in the coming years, some analysts say.
“Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits,” the Centers for Medicare & Medicaid Services (CMS) said Friday. “But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.”
It could be a huge boon to companies like American Well, MDLive and Teladoc and an array of startups getting into the business of offering access to physicians and patients via smart phone, tablet or computer. Employers and private insurers are already embracing the trend as a way to make healthcare more convenient and avoid costly and unnecessary trips to the emergency room or a more expensive physician’s office.
"This is a bold and important move by CMS, signaling to the rest of the healthcare system that telehealth based care is simply another form of care and should be treated as such,” MDLive’s chief medical officer and executive vice president of product strategy, Dr. Lyle Berkowitz said. “This is a rare win for providers, patients and payors.”
Increasingly popular Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some even providing vision and dental care and wellness programs. Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration, by the end of 2025, L.E.K. Consulting projects.
“With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth,” CMS Administrator Seema Verma said Friday in a statement. “By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”
Introduction and Summary
In 2017, Medicare Rights staff and volunteers addressed more than 15,000 questions and issues through the organization’s national helpline. In addition, over 2.8 million questions were answered for people with Medicare, their caregivers, and professionals serving them through Medicare Interactive, Medicare Rights’ free and independent online reference tool thoughtfully designed to help older adults and people with disabilities navigate the complex world of health insurance. This report will feature select helpline trends and highlight the most commonly searched for Medicare Interactive answers, providing a glimpse into the information and coverage needs of Medicare beneficiaries and their families.
As in previous years, helpline callers and users of Medicare Interactive were geographically and socioeconomically diverse, and needed help with a wide array of complex Medicare-related issues. Medicare Rights served clients in all 50 states. Approximately 30% of helpline callers were living on incomes of less than $19,000 per year. This number includes people dually eligible for Medicare and Medicaid, who represented 10% of all callers. Caregivers helping to resolve issues and asking questions for family members accounted for 20% of helpline callers. And around 25% of helpline callers were under 65 and eligible for Medicare due to disability. Medicare Rights has less robust demographic data on users of Medicare Interactive but knows that these users represent both beneficiaries and the professionals serving them, and the most popular sections in 2017 included one on Medicare-covered services and one that introduces Medicare eligibility and coverage topics.
Medicare Rights produces this report so that advocates, policymakers at the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA), and other stakeholders can better understand the needs of beneficiaries and work toward greater accessibility and affordability in Original Medicare and Medicare Advantage. For instance, in order to streamline and increase consumer awareness around Part B enrollment, the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, supported by Medicare Rights and further discussed in this report, was introduced in Congress in 2017. In 2018, additionally, Medicare Rights led advocacy efforts with CMS to extend the Medicare Part B time-limited equitable relief opportunity for Medicare beneficiaries who are enrolled in Marketplace health insurance instead of Medicare. Medicare Rights applauds CMS for extending and providing this relief opportunity through 2019 and beyond for those eligible in 2019 or prior years.
Around two-thirds of Americans receive their Medicare benefits through Original Medicare, and it is critical to protect Original Medicare as an important coverage option, even while Medicare Advantage may be the right choice for some beneficiaries. Medicare Rights expressed its concerns with CMS education and outreach materials prepared for the 2018 Medicare Annual Coordinated Election Period, which many perceived promoted Medicare Advantage over Original Medicare. CMS listened to Medicare Rights’ and other advocates’ concerns, and the final version of the 2019 “Medicare & You” handbook—the primary educational resource for those new to Medicare—was more balanced and accurate. Medicare Rights hopes that additional recommendations made in this report to increase Medicare’s responsiveness to beneficiary needs will be similarly heeded and acted on.
Through the program – which targeted at both Medicare Advantage beneficiaries and commercial members – Humana will support better care coordination and health outcomes through financial incentives.
The insurer said it will provide compensation for better care navigation based on quality and cost metrics across various parts of the patient journey ranging from inpatient admissions, ED visits, prescription drugs, diagnostics and radiology.
Humana lists 16 providers as inaugural participants in the program including multiple members of The US Oncology Network, along with health systems and practices like Cincinnati-based Tri Health and Kentucky’s Baptist Health Medical Group.
While the CMS Innovation Center has developed its own Oncology Care Model, the program is focused on episodes of care surrounding chemotherapy administration.
Humana is hoping to improve general cancer care for patients over the period of a year by emphasizing more face time between physicians and patients, access to proactive health screenings and the increased use of data analytics to better coordinate care around patients.
The new oncology program is the payer’s fourth specialty-care payment model, alongside bundled payment programs for Medicare Advantage spinal fusion patients and total joint replacement patients, as well as maternity care bundled payment programs for commercial group members with low-to-moderate risk pregnancies.
Humana has more than 2 million Medicare Advantage members and around 115,000 commercial plan members who are cared for by primary care physicians in value-based payment relationships.
In the company’s 2018 report on its value-based care practices, Humana found that MA members with physicians in value-based care relationships experienced 7 percent fewer emergency room visits and 5 percent fewer hospital admissions
Medical costs for patients who were affiliated with physicians in Humana MA value-based agreements were also 15.6 percent lower than traditional Medicare.
Humana’s recent activities are indicative of the larger payer industry making a full-scale business transition to value-based care.
Case in point, UnitedHealthcare is launching a Care Bundles program next year that will offer providers across 30 states the option of participating in bundled payment arrangements for eight medical procedures for MA patients.
By Michael Adelberg – STAT – April 4, 2019
Nearly a quarter century ago, then Speaker of the House Newt Gingrich said this about the original Medicare program: “We believe it’s going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.”
Gingrich argued that original Medicare — based on a 1960s-style fee-for-service benefit package with a confusing set of deductibles, co-insurance, and copays — was stuck in the past. He saw a day when Medicare-contracted private health plans would prove so attractive that Medicare beneficiaries would have to choose them.
It’s taken a generation, but Gingrich is on the verge of being right about Medicare.
Medicare began experimenting with managed care as an alternative to the original program in the 1970s, and annually contracted health plans — called Medicare+Choice — were made a permanent part of the program in the 1990s. Because of funding reductions, it initially floundered.
That changed in 2003 with the passage of the Medicare Prescription Drug, Improvement, and Modernization Act, which renamed the program Medicare Advantage, raised payment rates, and added risk adjustment to the payment methodology. Leading managed care companies, such as UnitedHealth Group, Humana, Aetna, and Blue Cross Blue Shield companies, began marketing Medicare Advantage products every fall. So did dozens of smaller and health system-owned health plans.
Enrollment in these plans has increased every year since then. Today, more than 22 million beneficiaries choose Medicare Advantage, about 35 percent of all people
with Medicare, up from about 11 million people a decade ago. This has occurred despite a gradual phase down in funding put in place by the Affordable Care Act.
In 2019, Medicare Advantage plans stepped up their coverage to include the delivery of meals, rides to physician appointments and pharmacies, home safety improvements, and a host of other new benefits. As described in a new report on Medicare Advantage plans that one of us (M.A.) co-authored, 153 Medicare Advantage plans are now leveraging new Trump administration guidance and experimenting with 842 “flex benefits” this year. These benefits fall into two broad categories: reducing costs to encourage members to receive preventive care, such as free primary and podiatry care for people with diabetes; and non-medical benefits, such as home-delivered meals following a hospital discharge, home safety interventions, and non-skilled in-home caregiving.
Medicare beneficiaries select Medicare Advantage for a variety of reasons. These include catastrophic cost protection, care management programs, and a range of mainly health-related supplemental benefits such as dental checkups, eyeglasses, hearing aids, over-the-counter drugs, and gym memberships. The trade-off for these extras is limited choice of providers and managed care tools like prior authorization. These limitations put off some Medicare beneficiaries, but have not dampened the high overall satisfaction with Medicare Advantage or its continued growth.
Medicare Advantage’s competitive edge over original Medicare will take another step forward in 2020 when plans are expected to gain additional flexibilities in offering non-medical benefits for people with chronic diseases. The next wave of new benefits can include anything that the Centers for Medicare and Medicaid Services deems “has a reasonable expectation of improving or maintaining the health or overall function” of enrollees with chronic diseases. While CMS has not yet offered its final guidance, this will likely include meals, transportation, pest removal, and activities that combat social isolation and depression, which could include companionship services and pet therapy.
Some of the brightest minds in managed care are working to determine whether relatively inexpensive, newly permissible benefits like these will pay for themselves by reducing the number of expensive medical procedures. Actuaries at Wakely Consulting, for example, have modeled the value of a falls reduction benefit. Using Medicare claims data, they determined that injury-causing falls are associated with spikes in medical costs that average about $10,000 compared to pre-fall costs. So an intervention that reduces falls by even 10 percent would likely pay for itself if it costs less than $1,000 per fall-prone member receiving the service. Hiring a handyman for a couple hundred dollars to install grip bars in a shower or modify cabinetry would be a bargain.
How does original Medicare stack up in comparison to Medicare Advantage? The Affordable Care Act and the Medicare Access and CHIP Reauthorization Act (MACRA) introduced value-based reimbursement reforms into original Medicare. These may make the program a more efficient payer, but they do not necessarily improve benefits for Medicare beneficiaries. Medicare Supplement Insurance (Medigap) continues to be purchased by roughly 13 million Medicare beneficiaries. It plugs gaps and simplifies original Medicare’s idiosyncratic coverage, but it is too expensive for lower-income beneficiaries. In addition, state and federal laws prevent Medigap from keeping up with Medicare Advantage.
A 2017 report by the National Association of Insurance Commissioners demonstrates that only a handful of states permit Medigap carriers to offer any “innovative” benefits. And the modest flexibilities permitted — such as eye exams — pale in comparison to the richness and diversity of Medicare Advantage benefits.
In subtle and unsubtle ways, the Trump administration has seeded the ground for massive gains in Medicare Advantage enrollment. These include loosened restrictions on marketing Medicare Advantage plans, new consumer tools that accentuate the advantages of these plans, greater use of telehealth than permitted in original Medicare, the elimination of “meaningful difference” tests that limit the number of Medicare Advantage plans in a given market, and extra time for plan sponsors to secure a provider network. Meanwhile, the administration has finalized a regulation that may substantially lessen the number of accountable care organizations participating in original Medicare — the original Medicare reform with the greatest potential to align providers in reimbursement systems outside of Medicare Advantage.
Congress has also quietly added tools to Medicare Advantage that aren’t available in original Medicare. A little-noticed MACRA provision will remove two of the most popular Medigap plans from the market in 2020, further weakening its value proposition versus Medicare Advantage. This is not an accident: Many conservatives have long disliked original Medicare’s centralized pay schedules and the perverse incentives of fee-for-service medical care. And many liberals are willing to strengthen Medicare Advantage if that’s the only way to offer more generous health care coverage to seniors.
Intentionally or not, Congress and various administrations have created two Medicare programs: the original fee-for-service program with rules and coverage that the private market largely abandoned decades ago, and a managed care program that has just benefited from another set of favorable legislative and regulatory tweaks. Maybe it is unfair that policy makers are favoring Medicare Advantage. But if this is the only way to deliver modern and more generous health benefits to Medicare beneficiaries, then a thumb on the scale is better than denying beneficiaries access to 21st-century benefits.
It’s no wonder that Medicare beneficiaries are voluntarily leaving original Medicare — voluntarily.
The estimate is for an enrolled-in-Medicare couple’s retirement
By Rebecca Moore – PlanAdviser – April 3, 2019
In case you’re wondering how much of your retirement savings might go toward health care, Fidelity has a new number – and it’s going up. A 65-year old couple retiring in 2019 can expect to spend $285,000 in health care and medical expenses throughout retirement, compared with $280,000 in 2018, according to Fidelity’s annual Retiree Health Care Cost Estimate.
For single retirees, the health care cost estimate is $150,000 for women and $135,000 for men. The estimate assumes both members of the couple are eligible for Medicare. While Fidelity’s estimate is for a couple retiring in 2019, the firm says it’s a call-to-action to younger generations to prepare – such as buying the right insurance products – for a lengthy retirement.
Tags: Retirement Planning
While this product is positioned for individuals who are Medicare eligible the issue age is 19 – 99 for these policies. For more information and to see rates view the Dental Insurance Product and Rate Guide.
Medicare supplement and Dental Insurance – Better Together
First, good dental care is important to overall health. But do you know Medicare doesn’t cover dental services? That means dental bills have the potential to take a bite out of people’s savings.
Second, there is a need among individuals age 65 and older for dental insurance.
Third, it is an easy sale. If you are taking a Med supp e-App the dental plans are quoted up front and with a few simple questions at the end of the app you can complete a dental sale. Also, all Med supp paper apps have the dental application included in the application book. And with our mobile quote app you can provide your clients a quote on the spot.
How to Make an UpLine Change
In order for a business to be successful all parties involved have to benefit or the relationship will eventually break down.
As an insurance agent, it’s likely only a matter of time until you find yourself in a situation where you feel that your upline partnership isn’t working for you.
When that happens, it may be time to cut ties with your current upline and move on. This can be a simple or complicated process, depending on your upline FMO and the carrier involved.
It is important first to understand that, if the carrier in question will honor a signed release from your upline, it needs to be from the highest level in your hierarchy. Carriers will not accept a signed release from a mid-tier FMO.
For example, as an FMO we have a direct relationship with the carriers we broker for. For the most part, carriers will honor our release requests, no questions asked.
We have a general open release policy and would normally process a release without delay. Having said that, we also give our mid-level down lines flexibility to implement their own release guidelines and allow them to release down lines as they see fit, as long as carrier guidelines are respected.
For the most part there are 2 ways to transfer your contract to a new upline. A “Signed Release” or a “Self-Release”.
Let’s take a look at these options:
An agent may request to be released from their upline for immediate transfer to a new FMO. It is important to stress that this request must be signed by the top level upline and NOT by a mid-tier. If the top line FMO signs the release, the agent is then free to transfer to a different broker immediately.
If an upline doesn’t want to give an agent an immediate release, then an agent can exercise the Self-Release process. It may vary by carrier, but as a general rule there are a couple of ways to do it:
Below is a sampling of a few carriers and their release process:
Aetna Med Advantage/Part D - Notice and new contracting must be sent to Aetna to start the clock. You can continue to write business during their 3 month Self-Release period.
Mutual of Omaha - Non-Production for 6 months will allow an agent to transfer their contract.
Aetna Med Supp - Email notice must be sent to Aetna Supplemental to start the clock. You can continue to write business during their 6 month Self-Release period. However, different guidelines apply if you have producing downlines.
Humana - Notice and new contracting must be sent to Humana to start the clock. You can continue to write business during their 3 month Self-Release period.
United Healthcare – Email notice must be sent to UHC to start the clock. You can continue to write business during their 6 month Self-Release period.
Some Med Advantage carriers implement transfer freezes in the 4th Quarter of each year, which prevents an agent from transferring their contract no matter what the release scenario may be. UnitedHealthcare, Aetna, and Humana are a few of the major carriers who implement a transfer freeze period.
With that being said, it’s important to carefully consider the timing if you’re looking to initiate a self-release.
For example: If an agent were to start a self-release and that self-release time frame expired in the middle of a transfer freeze (9/1/19 to 12/31/19), they would be forced to stay under their current upline until the end of the freeze period. In other words, they are stuck until after AEP and usually until January 1st of the next year.
Obviously, if the agent could have timed the self-release so that the self-release time frame expired before the freeze period, that may have been the more favorable situation.
Again, not all carriers have the same process, so ensure you understand the carrier’s requirements before starting the process.
The important thing to remember is that, if your business relationship isn’t working, you have options. It is also a good idea to understand the release policy of your upline, before you work with them, so you are not surprised when the situation arises.
Your success is up to you, but a bad business relationship can definitely make that success more difficult.
If you have any questions, our experienced marketers are here to help.
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