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Long-Term Care Providers Drive Growth in Special Medicare Advantage Plans

Posted by www.psmbrokerage.com Admin on Wed, Dec 26, 2018 @ 12:32 PM

Long-Term Care Providers Drive Growth in Special Medicare Advantage Plans


(Image: Freepik)

By SkilledNursingNews – December 19, 2018

Health care providers selling Medicare Advantage (MA) products isn’t a new trend, but typically “providers” refers to hospitals, health systems, or physician groups. Few would expect nursing homes and assisted living operators to be able or willing to manage health care risk for some of the highest-cost Medicare beneficiaries.

And yet, as these charts illustrate, long-term care providers are largely responsible for driving rapid growth (23%) in the number of MA special needs plans enrolling institutionalized Medicare beneficiaries over the last two years. The number of provider-sponsored I-SNPs doubled from 2016 to 2018, and enrollment has more than doubled. Long-term care providers now lead 21 of the 24 provider-led I-SNPs.

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Tags: Medicare Advantage, Medicare Advantage News

Medicare Advantage 2017 Spotlight: Enrollment Market Update

Posted by www.psmbrokerage.com Admin on Wed, Jun 07, 2017 @ 10:11 AM

Medicare Advantage 2017 Spotlight - Enrollment Market

Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade. The trend in enrollment growth is continuing in 2017, and has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA).

This Data Spotlight reviews national and state-level Medicare Advantage enrollment trends as of March 2017 and examines variations in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, and quality ratings. Key findings include:

Enrollment Growth- Since the ACA was passed in 2010, Medicare Advantage enrollment has grown 71 percent. As of 2017, one in three people with Medicare (33% or 19.0 million beneficiaries) is enrolled in a Medicare Advantage plan.

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Market Concentration - UnitedHealthcare and Humana together account for 41 percent of enrollment in 2017; enrollment continues to be highly concentrated among a handful of firms, both nationally and in local markets. In 17 states, one company has more than half of all Medicare Advantage enrollment – an indicator that these markets may not be very competitive.

Medicare Advantage Penetration - At least 40 percent of Medicare beneficiaries are enrolled in Medicare private plans in six states: CA, FL, HI, MN, OR, and PA. In contrast, fewer than 20 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 13 states, plus the District of Columbia.

Premiums and Cost-Sharing - While average Medicare Advantage premiums paid by MA-PD enrollees have been relatively stable for the past several years ($36 per month in 2017), enrollees may be liable for more of Medicare’s costs, with average out-of-pocket limits increasing 21 percent and average Part D drug deductibles increasing more than 9-fold since 2011; however, there was little change in out-of-pocket limits and Part D drug deductibles from 2016 to 2017.

Medicare Advantage enrollment is projected to continue to grow over the next decade, rising to 41 percent of all Medicare beneficiaries by 2027. As private plans take on an even larger presence in the Medicare program, it will be important to understand the implications for beneficiaries covered under Medicare Advantage plans and traditional Medicare, as well as for plans, health care providers and program spending.

OVERALL TRENDS IN ENROLLMENT

NATIONWIDE ENROLLMENT

In 2017, one in three (33%) Medicare beneficiaries – 19.0 million people – is enrolled in a Medicare Advantage plan (Figure 1). Total Medicare Advantage enrollment grew by about 1.4 million beneficiaries, or 8 percent, between 2016 and 2017. The growth reflects the ongoing expansion of the role of Medicare Advantage plans in the Medicare program.

TRENDS IN ENROLLMENT BY PLAN TYPE

As has been the case each year since 2007, about two out of three (63%) Medicare Advantage enrollees are in HMOs in 2017. One-third of enrollees are in PPOs – with more in local PPOs (26%) than regional PPOs (7%) – and the remainder are in Private Fee-For Service (PFFS) plans (1%) and other types of plans (3%), including cost plans and Medicare Medical Savings Accounts (MSAs).

• HMOs - Enrollment in HMOs increased by 0.6 million to 11.9 million beneficiaries in 2017 (Figure 2 and Table A1).

• PPOs - Enrollment in local PPOs increased by 0.8 million, with 4.9 million beneficiaries in local PPOs. In 2017, 1.3 million beneficiaries are in regional PPOs, similar to 2016.
A key difference between an HMO and a PPO is that the latter covers part of the cost of care from providers outside of the plan’s provider network. Local PPOs, like HMOs, are required to serve areas no smaller than a county, whereas regional PPOs are required to serve areas defined by one or more states.

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Read the full report

Source - http://files.kff.org/attachment/Issue-Brief-Medicare-Advantage-2017-Spotlight-Enrollment-Market-Update

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Tags: Medicare Advantage, Medicare Advantage News

Federal Regulators Release Medicare Advantage Payment Increase for 2017

Posted by www.psmbrokerage.com Admin on Tue, Apr 12, 2016 @ 03:39 PM

blog_pic_payment_increase.png

On April 4, the Centers for Medicare and Medicaid Services (CMS) released the final updates to the Medicare Advantage and Part D programs for 2017.  An article from Bloomberg on the same day summarizes the impacts of the increase across the industry.

The U.S. is raising payments to the insurers by 0.85 percent on average, according to a statement Monday from the Centers for Medicare and Medicaid Services, down from the 1.35 percent boost proposed in February. Payments to individual insurers can vary, because CMS gives individual plans quality bonuses and premiums are adjusted based on where enrollees live and how sick they are.

 The smaller increase gives less of an increase to top providers of Medicare Advantage plans such as UnitedHealth Group Inc. and Humana Inc. Other publicly traded insurers that are big providers of the private Medicare plans include Aetna Inc., Centene Corp., and WellCare Health Plans Inc. The U.S. raised rates by about 1.25 percent for this year, after a cut of about 4 percent in 2015. Medicare Advantage plans are run by private health insurers, and funded and regulated by the government.

Click here to read the Bloomberg article.

Click here to read the full release from CMS.

Source: https://www.csgactuarial.com/2016/04/federal-regulators-release-medicare-advantage-payment-increase-for-2017/

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Tags: Medicare Advantage, Medicare Advantage News, CMS

Medicare Advantage Tops 17 Million Members

Posted by www.psmbrokerage.com Admin on Thu, Apr 02, 2015 @ 11:49 AM

blog pic More than 17.3 million people were enrolled in Medicare Advantage plans as of March 2015. Year over year, total Medicare Advantage enrollment increased by more than 1.3 million as managed Medicare continues to be an attractive growth market for health insurance companies. The latest CMS (Centers for Medicare and Medicaid Services) reports indicate 54.3 million are eligible for Medicare in the United States and U.S. territories. Medicare Advantage (MA), with an unpenetrated market of 37 million and growing, is big business for many health plans. UnitedHealth and Humana lead the segment and each leader enrolls more than 3 million MA members. Kaiser Permanente and Aetna also command significant market share with more than 1.2 million MA enrolled.

This brief provides insights about competitive positioning in the Medicare Advantage market. We also assess market share for individually purchased versus employer-sponsored benefits and look at changes in Medicare Advantage plan type preferences.



Competitive Dynamics

Medicare Advantage (MA) enrollment stands at 17.3 million, which represents an 8% increase year-over-year. Ten companies, each with more than 250,000 members, have a sizeable stake in this segment and collectively they provide coverage for 67% of the market. Per the reference table below, all leading MA companies realized growth from March 2014 to March 2015 except for Anthem and Highmark. The aggregate net gain for the leading companies, year-over-year, was 8.2% and segment growth for all other MA companies was on par.

UnitedHealth retains its position as the top Medicare Advantage organization in the country; with 3.4 million enrolled, UnitedHealth owns 20% of the market. Humana ranks a strong second with 18% share and 3.1 million lives. Kaiser Permanente is positioned as third on the leader board, enrolling 7.5% of the total market or 1.3 million. Aetna trails closely behind Kaiser Permanente owning 7.2% of the market and more than 1.2 million lives.



Each year, Medicare Advantage plans rely on February and March enrollment reports to not only evaluate their standing but also assess which competitors gained and lost members during the last AEP (Annual Election Period). The AEP occurs between October 15 and December 7 each year and is also referred to as the Open Enrollment Period for Medicare Advantage and prescription drug plans.

This year, Humana experienced the largest gain in terms of membership, adding 369,747 members for a net gain of 13.2%. UnitedHealth's MA enrollment grew by 271,245 for a net gain of 8.5%. Aetna saw a net gain of 13.9%, adding 152,780 members to its MA book in the last year. Per the reference table below, membership gains were fairly substantial for other growth leaders in this segment, ranging from 83,365 for Kaiser Permanente to 32,729 for Blue Cross Blue Shield of Minnesota.

The majority of people with Medicare Advantage purchased a plan directly from the company and this is referred to as individual or direct purchase enrollment. As of March 2015, about 82% (approximately 14 million) of MA membership was individual. This speaks to why plans invest considerable time to devise market and selling strategies in preparation for the AEP every year.

Only 18% of total MA membership (slightly more than 3 million) originated through an employer group health plan or retirement health benefit. Nonetheless, group membership grew by 6% year-over-year primarily driven by UnitedHealth plan gains. Some companies strategically target group MA business because employers are interested in the cost savings MA plans can offer. Note that 57% of Aetna's MA membership is through group plans. Though many employers are shifting away from providing retirement benefits, larger volumes of people retiring may continue to sustain group Medicare Advantage opportunities over the next few years.

It is important to note that individual and group enrollment counts are slightly lower than total segment enrollment due to different reporting requirements.

 


http://www.markfarrah.com/healthcare-business-strategy/Medicare-Advantage-Tops-17...

 

Source: markfarrah.com

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Tags: medicare advantage updates, Medicare Advantage, Medicare Advantage News, medicare advantage enrollment,, ma enrollment,

Medicare Advantage – Who’s Covered?

Posted by Guadalupe Cantu on Fri, Oct 18, 2013 @ 11:31 AM

Medicare Supplements Many seniors and people with disabilities who are on traditional Medicare find themselves searching for additional coverage to cover for medical expenses that Medicare does not already cover. More and more of these beneficiaries find the help through private health coverage of Medicare Advantage plans.

Seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage, higher-quality care, better services, and additional benefits, reports The Coalition for Medicare Choices, a national grassroots organization who sole purpose is to protect and improve Medicare Advantage.

Medicare SupplementsWho’s covered? According to CMC’s website MedicareChoices.org, Medicare Advantage covers over 14 million people nationwide. Out of those 14 million, 41% are blue-collar workers who earn less than $20,000 year, 1 in 5 being minorities.

In February 15, 2013, the Centers for Medicare & Medicaid Service enrollment data showed Hawaii, Oregon, Arizona, Pennsylvania, California, Florida, Ohio, Rhode Island, New York, Nevada and Utah as having the highest traditional Medicare beneficiaries enrolled in Medicare Advantage.

Medicare SupplementsDoes Medicare Advantage have high satisfaction and better quality care? In a new survey from The North Star Opinion Research firm commissioned by America’s Health Insurance Plans (AHIP), found 9 out of 10 seniors are satisfied with their Medicare Advantage coverage.

It has also been reported that 13 out of 20% of beneficiaries with Medicare Advantage had fewer patient readmissions into hospitals than Medicare fee-for-service, according to the American Journal of Managed Care. The quality of care for seniors under the Medicare Advantage program has improved as well, outperforming Medicare fee-for-service in 9 out of 11 quality measures.


Please give us your feedback!
Question: Despite the recent government’s budget cuts changes made to Medicare Advantage program, do you feel Medicare Advantage satisfaction and quality measure will decline overtime or will it make it have the opposite effect?

 

Source: MedicareChoices.org

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Tags: Medicare Advantage, Medicare, Medicare Advantage News, Affordable Care, Medicaid

The narrowing of Medicare Advantage plans

Posted by Guadalupe Cantu on Fri, Sep 27, 2013 @ 10:00 AM

Medicare Supplements It’s no big secret that the government was looking for a way to pave the way for an entirely new health reform. A cost control measure, which would save over $132 billion within a 10 year span. The government found it through the budget cuts changes they made to Medicare Advantage.

In 2014, the Medicare Advantage plans available will decrease from to 2,664 plans in 2013 to 2,522,, a difference 5.3 percent, according to Avalere Health analyst.

Further driving the decline of Medicare Advantage plans is the Affordable Care Act payment cuts. Beginning 2014, Medicare Advantage plans are required by law, to lower cost and use 85 percent of their revenue on medical care and quality improvement efforts. Any Medicare Advantage participants who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of non compliance. Not all news is bad for Medicare Advantage plans. Quality bonus programs have been developed to reward plans that are higher in quality and more efficient than their counterparts, reports Centers for Medicare and Medicaid.

According to Peter Kongstvedt, MD, a noted insurance industry consultant and a member of MANAGED CARE’s editorial advisory board, the Medicare Advantage HMOs will do well because their rates are often below the fee-for-service equivalents and they have a track record of doing well in the past. He also believes Medicare Advantage PPOs will fare well.


Please give us your feedback!
What does this all mean to the seniors? Under the Affordable Care Act, everyone has the right to health insurance. Do you believe “the law” will help decrease rates?

 

Source: LifeHealthPro & Managed Care Magazine

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Tags: Medicare Advantage, Medicare Supplement, Medicare Advantage News, Medicare Part D, Affordable Care Act, Affordable Care, HMO

Medicare Advantage Plan Enrollment Hits Record High

Posted by Lauren Hidalgo on Fri, Jun 14, 2013 @ 09:53 AM

Medicare Supplements In 2013, there are currently 14.4 million Medicare beneficiaries enrolled in Medicare Advantage. This is an increase of more than one million (9.7%) from 2012 and sets a record high for enrollees. Even though there were concerns that payment changes from the Affordable Care Act of 2010 (ACA) would lead to fewer enrollments, it has seen an increase of 30% since 2010. About 28% of Medicare beneficiaries are enrolled in Medicare Advantage plans today and there is very little evidence of an adverse effect on enrollment in low versus high cost counties as a result of payment rate change in the ACA.

Don’t overlook the importance of adding a competitive Hospital Indemnity Plan to your senior care portfolio.


This growth is a continuation of the rapid growth in enrollment that occurred at the same time as the introduction of Part D in 2006. Also, the implementation of other changes to the Medicare Advantage program authorized by the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. This growth has happened despite the fact that the average number of plans available to enrollees nationwide declined from a high of 48 plans in 2009 to only 20 plans in 2012 and 2013.

With the Annual Enrollment period coming up, be sure to check out our Medicare Advantage product portfolio to make sure you have the best company rates in your area. If you have any questions about the products we offer or the Medicare Advantage market, please call our marketers at 1-800-998-7715.


Please give us your feedback!
Have you seen an increase in your Medicare Advantage business? Does this news make you want to add Medicare Advantage to your senior market portfolio?

 

Source: KHN

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How Healthcare Reform will Affect Med Supp Products

Posted by Lauren Hidalgo on Fri, May 31, 2013 @ 09:26 AM

Medicare Supplements The largest portion of healthcare reform Affordability and Accountability Act "ACA" is set to go into effect in 2014. For the most part the Medicare Supplement market will be largely unaffected by ACA with most of the impact resulting indirectly from changes to Medicare Advantage.

Possible impact to Medicare Supplements:

Medicare Supplement::

  • Section 3210 of ACA required the NAIC to add a nominal cost sharing to plans C and F (however, the NAIC has recommended no cost sharing to plans C and F due to lack of evidence this would decrease utilization. This has not been decided upon.)
  • Mostly unaffected by ACA, as long as Plan F doesn't change

Medicare Advantage:
  • Medicare Advantage plans will be held to a minimum loss ratio of 85%
  • Restructures the funding levels to Medicare Advantage plans in order to reduce the payments closer to traditional Medicare
    • CBO estimates this will cut approximately $145 billion over the next 10 years
    • The payment restructuring was designed to be implemented over 3-6 years, which began in 2011

The changes to ACA may even prove positive for the Medicare Supplement market. Medicare Supplements will not be affected by minimum loss ratio changes or any major plan changes, whereas the Medicare Advantage market will most likely have a higher minimum loss radio requirement and continued political pressure on funding.

If there are any Medicare Supplement carriers you’d like to add to your portfolio, give your marketer a call at 1-800-998-7715; they can assist you with more information on all of the carriers PSM offers.


Please give us your feedback!
Do you think the ACA will affect your Medicare Supplement sales? Your Medicare Advantage sales?

 

Source: CSG Actuarial

Tags: senior market news, Medicare Supplement, Medicare News, Medicare Advantage News, Medicare Sales

2014 Medicare Advantage and Part D Maximum Commissions

Posted by Lauren Hidalgo on Fri, May 24, 2013 @ 08:38 AM

Medicare Supplements The CMS (Centers for Medicare and Medicaid Services) has released the maximum commissions a company can pay to an individual producer for Medicare Advantage and PDP for 2014. In some cases, commissions could be less than the amounts released, depending on that specific insurance company’s contract.

Medicare Advantage:

  • National - $425 initial and $213 renewal/replacement
  • Connecticut, Pennsylvania and District of Columbia - $480 initial and $240 renewal/replacement
  • California and New Jersey - $532 initial and $266 renewal/replacement
Part D (PDP’s):
  • All states - $56 initial and $28 renewal/replacement

Medicare Supplements Precision Senior Marketing will be closed Monday, May 27 for the Memorial Day holiday. Regular 8am-5pm CDT hours will resume Tuesday, May 28. We wish you and your loved ones a Happy Memorial Day. PSM would like to thank our Armed Forces for serving our country and protecting our freedoms.



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Tags: Medicare Advantage, Medicare Advantage News, CMS, UnitedHealthcare

Proposed Medicare Advantage Cuts Reversed

Posted by Lauren Hidalgo on Fri, Apr 05, 2013 @ 09:58 AM

Medicare SupplementsOn Monday the Centers for Medicare & Medicaid Services scrapped the proposed 2.2 percent cut to Medicare Advantage plans. America’s Health Insurance Plans (AHIP) was against the decrease all along, launching a campaign lobbying against it which included television ads, studies defending Medicare Advantage, and a letter-writing campaign with members of Congress. AHIP argued that seniors and those with disabilities enrolled in these plans would face higher premiums, reduced benefits and some loss of coverage options if these cuts were put into effect.

Instead, the Medicare agency announced that it would offer a 3.3 percent payment increase for next year. Jonathan Blum, CMS acting principal deputy administrator explained, "The policies announced today further the agency’s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice."

AHIP praised the agency for avoiding what it termed a "crushing blow" to Medicare Advantage beneficiaries. President and CEO of AHIP, Karen Ignagni, stated "CMS has taken an important step to help stabilize Medicare Advantage at a time when the program is facing significant challenges." She continued by saying that AHIP will continue to work with policymakers in both parties "to strengthen this critically important part of Medicare that provides high-quality, affordable coverage to more than 14 million seniors and people with disabilities."

This change is seen as a huge victory for health insurance lobbyists who worked very hard to reverse these potentially devastating cuts. However this is hardly the end of the Medicare Advantage trial. Medicare Advantage plans are still on the road to several major long-term alterations in the next few years. We will just have to wait and see which ones actually go into effect.


Please give us your feedback!
Does this reversal suprise you? OR did you figure their cuts wouldn't go through? What do you think is next for Medicare Advantage?

 

Source: Benefitspro.com, National Review

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Tags: senior market news, Medicare Advantage News, Cigna Medicare Supplement, Omaha Insurance Company, Sentinel Life Hospital Indemnity

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