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Medicare Advantage rebates to hit new highs in 2020

Posted by www.psmbrokerage.com Admin on Mon, Dec 09, 2019 @ 02:42 PM

Medicare Advantage rebates to hit new highs

Medicare Advantage (MA) rebates are expected to be $122 per enrollee next year, reaching a historic high, according to a new report.

The Medicare Payment Advisory Commission’s (MedPAC's) analysis, released Friday, comes as the open enrollment for Medicare ends Saturday. The analysis also dinged the MA Quality Bonus Program as not a good basis for judging the quality of MA plans.

Overall, MedPAC found MA is healthy, with enrollment growing rapidly. This year, 22.5 million Medicare beneficiaries have an MA plan, a 10% increase from 20.5 million in 2018 and an 86% increase from 12.1 million in 2011.

Plan choices are also increasing, with the average beneficiary able to choose from 27 plans next year, up from 23 in 2019.

But the analysis cast doubt on how MA plans are reimbursed by the Centers for Medicare & Medicaid Services.

Medicare pays plans through bids, where plans submit bids that are compared to a benchmark amount. If a bid is lower than the benchmark, the plan gets a rebate. The benchmark is based on a formula that looks at traditional Medicare costs for the geographic area where the plan is based.

Rebates have been steadily increasing for MA plans from 2016 to 2020.

In 2016, MA plans got an average monthly rebate per enrollee of $81, but that is expected to increase to a record high of $122 per enrollee in 2020. Average monthly rebates were $107 this year and $95 last year.

Benchmarks are increased for plans based on their overall quality scores, as the rebate percentage ranges from 50% to 70% based on quality scores.

But the analysis found problems with how quality is meaningfully evaluated in MA plans.

“Using the MA contract as the reporting unit is the source of many flaws in the current system,” said MedPAC staff member Andy Johnson during the commission’s meeting Friday.

The quality bonus program generates about $6 billion in payments to highly rated contract plans.

But MA plans can consolidate contracts that stretch across large geographic areas, so the contract isn’t a good indicator of coverage quality in a certain area, Johnson said.

Another problem is that the bonus program “uses a large number of measures, including administrative measures, to judge quality,” he added. “Some have sample sizes too small to provide a valid representation of quality in MA.”

MedPAC has called for a redesign of the quality bonus program previously.

The commission’s June 2019 report to Congress calls for creating a value incentive program that would use a small set of “population-based outcome and patient experience measures to evaluate MA quality.”

Source: https://www.fiercehealthcare.com/payer/medpac-medicare-advantage-rebates-to-hit-new-highs-2020

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Tags: Medicare Advantage, Medicare

A big clue for 2021 Medicare Advantage plans

Posted by www.psmbrokerage.com Admin on Thu, Dec 05, 2019 @ 02:00 PM

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Tags: Medicare Advantage, Medicare

The Future of the Medicare Program

Posted by www.psmbrokerage.com Admin on Thu, Dec 05, 2019 @ 01:49 PM

The Future of the Medicare Program

As the debates amongst Democratic presidential candidates over single-payer health care reaches new heights, the Trump administration recently responded with its latest executive order targeting health care, laying out the administration’s vision for the future of the Medicare program.

Historically, improving the health system has been a bipartisan goal albeit with different visions of how to best do so. Most policy makers agree that Americans need to get the right care, at the right time, in the right place, from the right provider—and that the current system is financially unsustainable. Democrats have traditionally focused on coverage expansion and reducing consumer costs, the former best exemplified by the 2010 passage of the Patient Protection and Affordable Care Act (ACA). In contrast, Republicans have focused on consumer choice, increased competition, and total cost reduction, best manifested by the managed competition model for Medicare Part D in the 2003 Medicare Modernization Act (MMA). In reality, all of these facets are needed for meaningful health reform.

Recent administration efforts have tracked traditional market-oriented principles, with previous White House policy positions and executive orders focused on choice and competition.

Medicare Advantage: Market-Driven Medicare

Medicare Advantage (MA), the market-driven alternative to the traditional fee-for-services Medicare program, plays a central role in the executive order. With participation doubling over the past decade, more than one in three beneficiaries, or 22 million Americans, participate in MA. Plan design has proliferated to provide customized benefit design for beneficiaries including health maintenance organization, local and regional preferred provider organizations, and special needs plans targeting dual-eligible and institutionalized beneficiaries.

The executive order proposes further flexibility in benefits and plan design: Medicare Medical Savings Accounts (MSA), supplemental benefits, and telehealth services. Medicare MSA plans function similar to health savings accounts (HSAs), in which a consumer selects a high-deductible MA plan and uses funds that they place in the MSA to pay for medical expenses until their deductible is met. Politically popular with many conservatives, MSAs have had little uptake since their introduction. MSA plans—like HSAs—depend upon both price transparency and high consumer health literacy, both of which are not features of current health care markets.

While efforts by the Centers for Medicare and Medicaid Services (CMS) to implement price transparency are laudable, it is reasonable to expect a sustained industry court challenge. Historically, health systems resisted price transparency efforts, citing both the difficulties in communicating meaningful prices in the setting of poor consumer health insurance literacy and price opacity as core to the business model of third-party payment.

As proposed, expansion of telehealth services could prove beneficial. Market evidence for cost control and quality benefits from telehealth is mixed: There is evidence for high utility in screening and other clinical preventive services, while other work demonstrates increased access to care, suggesting that telehealth meets otherwise unmet, pent-up demand by increasing access. Regardless, previous CMS efforts to broaden use of telehealth services could be expanded in multiple ways, most notably by integrating availability of telehealth services into star ratings and network adequacy requirements—beneficiaries should be able to choose not only when but how they receive medical services.

Medicare Advantage And Traditional Medicare: Wrestling For Dominance

A longstanding complaint from health plans is the differential treatment of private plans as compared to fee-for-service Medicare. The executive order proposes leveling this playing field with multiple opportunities for positive change in not only program administration but also in rulemaking and legislative activity.

Administratively, the “Welcome to Medicare” booklet—sent to all new beneficiaries—initially only briefly addresses MA plans, leaving a detailed description until page 55. The enrollment process defaults beneficiaries into fee-for-service, requiring beneficiaries to both elect Part B (most do) and then elect an MA plan.

To capitalize on the budgetary and care coordination benefits of MA for both beneficiaries and government, CMS could modify the enrollment process to promote auto-enrollment into high-performing MA plans. This would likely require additional legislative authority and could prompt objections by progressive Democrats.

However, it would help shift the balance from an open-ended financial commitment—fee-for-service Medicare—to a risk-adjusted capitated-plan product—MA—thus facilitating long-term budgetary control over the Medicare program. Beneficiaries would benefit as MA promotes coordination of otherwise siloed Part A, Part B, and Part D benefits.

Read the full article here.

Source: https://www.healthaffairs.org/do/10.1377/hblog20191203.919952/full/

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Tags: Medicare Advantage, Medicare

No Itch to Switch: Few Medicare Beneficiaries Switch Plans During the Open Enrollment Period

Posted by www.psmbrokerage.com Admin on Mon, Dec 02, 2019 @ 02:42 PM

No Itch to Switch: Few Medicare Beneficiaries Switch Plans During the Open Enrollment Period

Each year, Medicare beneficiaries in private Medicare Advantage plans and Part D stand-alone prescription drug plans (PDPs) have the opportunity to change plans during the annual open enrollment period (October 15 to December 7). Medicare’s private plans vary significantly from each other and can change from one year to the next, which can have a significant impact on enrollees’ coverage and costs. The Centers for Medicaid & Medicare Services (CMS) encourages beneficiaries to shop for Medicare Advantage and prescription drug plans to potentially save money on prescriptions or get new benefits.

Understanding how Medicare private plan markets are working is increasingly important for both beneficiaries and the Medicare program overall. Many presidential candidates and policymakers have proposed establishing a public program, modeled on Medicare, to expand coverage, while others want to expand the role of private plans within Medicare itself. To inform these discussions, this analysis examines the share of people enrolled in Medicare Advantage prescription drug plans (MA-PDs) and PDPs who switched plans for the following year during the open enrollment periods between 2007 and 2016, the most current year available for analysis of Medicare private plan switching rates. This analysis excludes enrollees with low-income subsidies; more detailed methods are described below.

Overall, a small share of MA-PD and PDP enrollees without low-income subsidies (8% and 10%, respectively) voluntarily switched to another plan during the 2016 annual open enrollment period for the 2017 plan year (Figure 1).

Among 9.4 million MA-PD enrollees without low-income subsidies, 7.6 percent (710,000 beneficiaries) voluntarily switched to another MA-PD during the 2016 open enrollment period for 2017, and another 0.9 percent (90,000 beneficiaries) switched from an MA-PD to traditional Medicare (with a PDP). Among 11.7 million PDP enrollees without low-income subsidies, 8.3 percent (980,000 beneficiaries) switched to another PDP and another 1.7 percent (200,000 beneficiaries) switched to an MA-PD during the 2016 open enrollment period for 2017. (A very small share of Part D enrollees switch to MA-only plans or traditional Medicare without Part D coverage; they are excluded from this analysis.)
A substantial majority of Medicare private plan enrollees have not voluntarily switched plans in any given year over the time period of this analysis. During the open enrollment periods between 2007 and 2016, the share of enrollees without low-income subsidies voluntarily switching plans for the coming year ranged between 6 and 11 percent for people in Medicare Advantage drug plans, and between 10 and 13 percent among those in stand-alone drug plans (Figure 2).

Some share of people who did not switch in any given year are beneficiaries who were enrolled in plans that exited the market and were “crosswalked” (i.e., automatically enrolled) by their plan sponsor into a new plan the following year. This means their plan is different from the previous year, but they did not voluntarily choose a new plan. For the 2017 plan year (corresponding to the 2016 open enrollment period), this comprised roughly 8 percent of MA-PD enrollees and 3 percent of PDP enrollees. Another small share of enrollees involuntarily switched MA-PDs (3%) or PDPs (<1%) because their plan exited the market for 2017 and they were not automatically crosswalked into a new plan.
Based on our analysis of the Medicare Current Beneficiary Survey, in 2017, more than one in three (35%) Medicare beneficiaries living in the community said it is very or somewhat difficult to compare Medicare options, and this share increased among beneficiaries in fair or poor self-reported health (44%) and with five or more chronic conditions (40%).
In 2017, nearly half (45%) of people on Medicare living in the community said they rarely or never review or compare their Medicare options; the share was substantially higher among beneficiaries ages 85 and older (57%).

Discussion

With an average of 28 Medicare Advantage plans and 28 stand-alone Part D plans available to beneficiaries in 2020, beneficiaries have dozens of plan options from which to choose. Relatively low rates of plan switching during the open enrollment period could indicate that beneficiaries are generally satisfied with their current plan and therefore have little motivation to compare and switch plans, or they may be actively choosing to remain in their plan after comparing other available options.

But, low switching rates could also indicate that many beneficiaries find the process of comparing plans too challenging, are unaware of the open enrollment period, or have limited confidence in their ability to choose a better plan. Both Medicare Advantage and stand-alone drug plans can vary significantly in terms of premiums, deductibles, cost sharing, provider and/or pharmacy networks, and drugs covered, among other plan features. Comparing all of these factors simultaneously is the best way to maximize value and lower costs, but it is also time consuming and challenging, especially for beneficiaries with cognitive impairments or serious health needs.

Our finding that a majority of MA-PD and PDP enrollees stay in the same plan during the annual open enrollment period may not be a concern, but it raises a question as to whether “stickiness” leads to avoidable costs, or unrealized benefits, for a large share of the Medicare population. The finding that nearly half of all Medicare beneficiaries say they never or rarely compare plans suggests that many beneficiaries may be unaware of important differences across plans that could have a significant impact on their coverage, costs, and, in the case of Medicare Advantage plans, access to certain providers. This is not surprising given the sheer number of Medicare private plans now available and the many ways in which they differ. Given that some presidential candidates and policymakers are discussing proposals to build on Medicare and the marketplace model or to broaden the role of private plans in Medicare, understanding the barriers that people on Medicare experience will continue to be important for policy discussions.

Source: https://www.kff.org/medicare/issue-brief/no-itch-to-switch-few-medicare-beneficiaries-switch-plans-during-the-open-enrollment-period

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Tags: Medicare Advantage, Medicare Part D, AEP

Medicare Advantage Beneficiaries Will Again See a Jump in Supplemental Benefit Offerings in 2020

Posted by www.psmbrokerage.com Admin on Mon, Nov 25, 2019 @ 04:24 PM

Medicare Advantage Beneficiaries Will Again See a Jump in Supplemental Benefit Offerings in 2020

Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits following administration’s policy changes from a year ago.

New analysis from Avalere finds that MA plans will continue to increase their supplemental benefit offerings in 2020, following increased flexibility provided by the Centers for Medicare & Medicaid Services (CMS) for the 2019 plan year. Supplemental benefits are additional services offered by MA plans that are not covered under Medicare Part A, Part B, or Part D, including transportation to physician visits, coverage of OTC drugs, meals, and other supplemental services that promote beneficiary health and wellness.

The key supplemental benefits that have been increasingly offered by plans from 2018 to 2020 include meals, transportation, acupuncture, and over-the-counter (OTC) benefits, among others (Table 1).

The big 3 supplemental benefits (vision, hearing, and dental) are now almost universally available (98%, 93%, and 87%). The notable increase in telehealth is associated with the change in the data reporting structure, which in 2020 allows plans to specifically indicate that they provide telehealth as a supplemental benefit.

In addition, plans were able for 2020 to include additional telehealth services as basic Medicare benefit in their Part A and Part B bid submissions to CMS in order for them to be paid for by Medicare. This change may have led plans to report telehealth as a supplemental benefit because the reporting tool does not yet allow plans to report it as a basic benefit.

In addition, 2020 is the first year when MA plans are allowed to offer non-primarily health-related special supplemental benefits for the chronically ill (SSBCI) such as food and produce, home-delivered meals (beyond a limited basis), pest control, and transportation for non-medical needs. However, the information on those benefits has not been released yet by CMS.

“While we now have insight into the majority of supplemental benefit offerings in 2020, we are still waiting for CMS to release data on SSBCI benefits that will be targeted at specific populations,” said Joanna Young, associate principal at Avalere. “More importantly, these are the non-primarily health-related benefits that will allow plans to start to address social determinants of health, and we are very interested in seeing what plans are going to do.”

Methodology

Avalere analyzed MA plan benefits data in the Q1 2020, Q4 2019, and Q4 2018 plan benefit package (PBP) files released by CMS. Due to different naming conventions that plans use to describe their supplemental benefits—primarily those not associated with specific rubric/category in the PBP file structure—our counts might be underestimating the actual availability of specific supplemental offerings. Avalere excluded MA plans with no drug coverage, Employer Group Waiver Plans, Cost, PACE and Demo plans from the analysis. The analysis includes MA plans in the 50 states, DC, and the territories.

Source: https://avalere.com/insights/medicare-advantage-beneficiaries-will-again-see-a-jump-in-supplemental-benefit-offerings-in-2020

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Tags: Medicare Advantage

CMS unveils plans to resolve Medicare overpayments

Posted by www.psmbrokerage.com Admin on Mon, Nov 18, 2019 @ 03:58 PM

CMS unveils plans to resolve Medicare Advantage overpayments

CMS has unveiled an approach to recoup funds that were paid by original Medicare that should have been billed to Medicare Advantage insurers.

The agency said the overpayments stem from providers failing to screen fully patients for insurance coverage and for billing Medicare fee-for-service for care that they should have billed to Medicare Advantage plans. CMS also blamed former Medicare administrative contractor, Cahaba GBA, for not catching the erroneous payments.

A notice posted by Palmetto GBA — the new Medicare contractor — says Palmetto and CMS will begin resolution of the overpayments in the coming weeks. The notice said hospitals, rural health clinics and other providers involved in the overpayments will receive, depending on their specific situations and claims, one, two or three letters about the issue.

The first letter is scheduled to go out later this month and will identify those overpayments relating to this issue that have been voluntarily resolved by several dozen Medicare Advantage organizations, which together sponsor nearly 200 plans. These MA organizations agreed to voluntarily give back $26 million to original Medicare to resolve 133,000 erroneous claims, according to the notice and Georgia Health News.

The second letter is scheduled to go out in December and will identify the overpayments that providers may rebill to three dozen Medicare Advantage organizations, which together sponsor 108 plans. The notice says these MA organizations agreed to allow providers to bill their claims again "or otherwise pursue payment, even though their respective claims filing deadlines had passed."

The third letter, scheduled to go out in January, addresses about $12 million of the MA plan overpayments that were unresolved because Medicare Advantage organizations did not make a voluntary repayment or arrange for claims to be rebilled. In the third letter, there will be a settlement offer from CMS related to the unresolved claims, according to the notice.

"Providers that accept the CMS settlement offer will retain a sizable portion of the original payments but will need to repay the balance specified in the settlement offer," the notice states. "Providers that do not accept the CMS settlement offer will receive a Medicare demand letter for the full balance, which they will need to repay; however, these providers will be permitted to pursue appeals on any of the claims if they wish to."

Read the full notice here.

Source: https://www.beckershospitalreview.com/finance/cms-unveils-plans-to-resolve-medicare-advantage-overpayments-to-providers.html

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Tags: Medicare Advantage

Medicare Open Enrollment "Half-Time" Snapshot: 84% of Those Selecting Medicare Advantage Choose Plans with $0 Premiums

Posted by www.psmbrokerage.com Admin on Mon, Nov 18, 2019 @ 03:44 PM

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Tags: Medicare Advantage, Medicare Open Enrollment Period, 2020

Telehealth in Medicare Advantage: Policy Issues and Recommendations

Posted by www.psmbrokerage.com Admin on Thu, Nov 14, 2019 @ 11:29 AM

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WellCare PDP 2020 Bank Draft Details

Posted by www.psmbrokerage.com Admin on Thu, Nov 14, 2019 @ 10:32 AM

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Medicare Advantage Penetration by State and County

Posted by www.psmbrokerage.com Admin on Wed, Nov 13, 2019 @ 11:35 AM

Medicare Advantage Penetration
by State and County

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.

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

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).

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

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.

Source: https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2019/

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Tags: Medicare Advantage

Medicare Blog | Medicare News | Medicare Information

Medicare Advantage rebates to hit new highs in 2020

A big clue for 2021 Medicare Advantage plans

The Future of the Medicare Program

No Itch to Switch: Few Medicare Beneficiaries Switch Plans During the Open Enrollment Period

Discussion

Medicare Advantage Beneficiaries Will Again See a Jump in Supplemental Benefit Offerings in 2020

CMS unveils plans to resolve Medicare overpayments

Medicare Open Enrollment "Half-Time" Snapshot: 84% of Those Selecting Medicare Advantage Choose Plans with $0 Premiums

Telehealth in Medicare Advantage: Policy Issues and Recommendations

WellCare PDP 2020 Bank Draft Details

Medicare Advantage Penetration by State and County

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

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

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