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Medicare Blog | Medicare News | Medicare Information

What Medicare Advantage means for private insurers

Posted by Guadalupe Cantu on Fri, Nov 15, 2013 @ 03:36 PM

Medicare AdvantageAs seniors reach 65 many are faced with a lot of questions about their health, health coverage, and the many plans accessible to them. Currently there has been a tremendous enrollment increase for Medicare Advantage (MA) plans or Medicare Plan C as they are known. This growth has been on the rise since 2004, and it currently makes up about 25 percent of traditional Medicare enrollee opting for MA plans, reports the Kaiser Family Foundation. This trend has more the doubled beneficiaries’ enrollment from 5.3 million to 13.1 million in 2012.
According to the Congressional Budget Office, Medicare Advantage enrollment is expected to grow from 14 million, in 2013, to 21 million by fiscal year 2023.

What it means to seniors?
More and more seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage which are of higher-quality care, with better services, and provide additional benefits. These plans are also used by elderly and people with disabilities to cover additional medical expenses that Medicare does not already cover.  Additionally, MA plans are more likely to be purchased by healthy seniors than other supplemental insurance options because these policies are more affordable on a monthly basis.

Cost savings is the driving force behind the increased enrollment of Medicare Advantage plans. With Medicare’s Part A, the insured is provided with inpatient hospital care; however, the enrollees are stuck to cover fluctuating deductibles associated with this plan yearly. Part B covers doctor’s expenses and preventive services, such as, flu. Medicare Part C is the Med Advantage plan that covers the additional expenses not covered by both Part A and B plans, excluding End-Stage Renal.

Further savings can be seen with MA premiums. The Kaiser Family Foundation reports that 50% of seniors enrolled in Medicare Advantage plans have no extra premiums, and two-thirds enrolled in the HMO Advantage plans pay nothing extra.

What does this growth mean to private insurers?
Earlier this year the House mandated a proposal that would make payment cuts to MA plans beginning 2014. By law, Medicare Advantage plans are required by law, to lower cost as much as 7 to 8%, and use 85 percent of their revenue on medical care and quality improvement efforts. Those who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of noncompliance.

However, that proposal changed when the Centers for Medicare and Medicaid Services (CMS) decided to increase payments by 3.3 percent. The proposed change could average $50 or more per month for a Med Advantage enrollee.  According to the CMS, the change was made to improve program stability and payment accuracy.

Selling Medicare Advantage plans is not as simple as having a basic health insurance license. By law, CMS requires agents, brokers and all licensed sales representatives to complete a CMS certification program before any marketing and selling can be done.

Additionally, with the certification comes responsibility. It is very important for agents to educate enrollees to what exactly the products they are buying.

Another factor private insurer’s face is the CMS Complaint Tracking Module. The CTM is a complaint tracking module used to track the accuracy of incidents and complaints, responses to those complaints and to ensure compliance.
  
With the advancement in technology, private insurers should embrace the latest technologies to facilitate the response time to any compliance needs. And with the help of their well-trained CMS certified representatives and producers, they should be able to quickly address any concerns or request their clients may have.


Please give us your feedback!
Question: Do you feel that the CMS abrupt change to increase MA payments by 3.3% will further encourage the quality of care seniors receive? Will this help insurers improve CTM compliance?

Source: LifeHealthPro
Additional Updates:

    • 2014 Medicare Advantage and Part D Certifications are now available! Learn More

Tags: Beneficiaries, Centers for Medicare & Medicaid Services, Medicare benefits, Medicare Part A, Medicare Part B, Medicare Advantage, Medicare, Medicare News, Medicaid

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