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Highmark Medicare plans will lose in-network access to UPMC in 2019

Posted by www.psmbrokerage.com Admin on Tue, Aug 07, 2018 @ 03:57 PM

Highmark Medicare Plans will lose in-network
access to UPMC in 2019

Highmark Medicare plans will lose in-network access to UPMC in 2019Thousands of seniors with Highmark’s Medicare Advantage plans will lose in-network access to UPMC hospitals a year earlier under a Wednesday state Supreme Court decision than they would have under a lower court’s ruling.

Seniors with the plans will lose in-network access at the end of June 2019, when a state-brokered consent decree between the two health care giants expires. A Commonwealth Court judge had interpreted the consent decree to mean UPMC would have to continue to accept the insurance through June 2020.

highmark“We are disappointed in today’s Pennsylvania Supreme Court ruling,” Highmark spokesman Aaron Billger said in an emailed statement. “While this is not how we interpreted the consent decrees intended to guide the Highmark and UPMC relationship, we will work in full compliance with the ruling and trust UPMC will do the same.”

Doctor visits and hospital services typically cost much less when the doctors and hospitals are in an insurer’s network than when they aren’t. Seniors with Highmark Medicare Advantage plans who see UPMC doctors will have to either switch doctors or pay much higher prices to see their UPMC doctors as of next July. Or they can switch insurers during the open enrollment period for the plans, which will run from Oct. 15 to Dec. 7, to pick a plan that includes their UPMC doctors and hospitals.

Some Highmark Medicare Advantage plans include access to UPMC hospitals and doctors and some don’t. About 50,000 seniors living in Allegheny and Erie counties have Security Blue and Freedom Blue plans, which include UPMC, Billger said. People with Community Blue plans, which don’t include UPMC, won’t see any changes, he said. About 17,000 seniors in Westmoreland County have Medicare Advantage plans that provide access to UPMC.

UPMC“UPMC is grateful the Supreme Court expeditiously reached this decision, allowing seniors ample time to make the best choices for their health care,” UPMC spokesman Paul Wood said in an emailed statement.

The change to networks coming in the middle of the plan year could create confusion for seniors who don’t know it’s coming, said Bill McKendree, coordinator for the Allegheny County APPRISE program, which helps seniors with enrollment.

McKendree said the federal Centers for Medicare and Medicaid Services could decide to create a special window in which seniors losing access to UPMC doctors could switch plans after June 30. Or CMS might not do that, he said.

“This is a big old question mark,” he said.

UPMC Health Plan, Aetna, Cigna and United Healthcare have all sold Medicare Advantage plans in the region in previous years. Highmark owns Allegheny Health Network and includes its hospitals in its plan networks.

Seniors may also elect to enroll in traditional Medicare, rather than the Medicare Advantage plans. The traditional program includes all hospitals and doctors in the country who accept Medicare. McKendree advises seniors considering traditional Medicare to think about getting a Medigap supplemental plan, which covers many of the co-pays, deductibles and other costs of traditional Medicare. McKendree said all hospitals and doctors who accept Medicare must accept Medigap.

The state brokered the consent decree between Highmark and UPMC in 2014 to govern relations between them until 2019. The two nonprofits had been unable to resolve contract disputes on their own that arose after Highmark Inc. announced it was buying the former West Penn Allegheny Health System to form the basis of Allegheny Health Network. UPMC said it wouldn’t contract with an organization owning competing hospitals.

Source

Additional Updates:
  • Gen Re Medicare Supplement Survey results - View / PDF
  • Aetna releases new telephonic enrollment tool for Medicare Advantage sales - View
  • Payments to Medicare Advantage plans has nearly doubled - View
  • Fed to allow short-term health plans - View
  • 2019 Medicare Advantage / Part D Certifications now available - View
  • 2019 First Looks now available for all major carriers - View
  • 2019 AEP Road Map - Start planning today - View
  • Increase your sales with our complimentary tools and tech - View
  • Express: Mutual of Omaha weekly updates - View
  • VALUES Quote of the Week - View
  • Current agent incentive trips and contests - View

Tags: Medicare Advantage plans, Medicare

Aetna releases New telephonic enrollment option for Medicare Advantage Sales

Posted by www.psmbrokerage.com Admin on Tue, Aug 07, 2018 @ 01:43 PM

Aetna releases New telephonic enrollment option for Medicare Advantage sales

Aetna releases New telephonic enrollment option for Medicare Advantage Sales


The Remote Agent Telephonic Enrollment (RATE) tool is a powerful, new feature that lets you enroll your clients by phone, after you’ve completed the initial face-to-face meeting with them. It’s available through the Ascend Virtual Sales Office app.

To use RATE, you must have an iPad. You’ll also need to complete a short user training and quiz. Just contact us at 800-998-7715 to schedule a training session.

How it works

Step 1: First, you meet with your client and provide the required sales presentation and materials. (Please note that RATE does not replace your one-on-one client appointments.) If your client decides to enroll sometime after that meeting, you can schedule an appointment to complete the enrollment by phone.

Step 2: At the scheduled date and time, your client will call you on your unique RATE-specific 1-800 phone number. You’ll receive that call on your iPad.

Step 3: Next, you’ll walk them through an approved telephonic enrollment script that’s built into RATE to complete the enrollment. The calls are instantly and automatically recorded.

What are the benefits?

  • Save money — Enrolling by phone saves you from driving back to clients’ homes to complete their enrollment. You’ll save on gas, tolls and vehicle wear and tear.
  • Save time — RATE helps shorten the sales cycle, so you can see more clients.
  • Ensures compliant selling — When you use this option, the enrollment call is instantly and automatically recorded, which can help protect you from complaints

Read the full PDF document here

Additional Updates:
  • Thrivent Medicare Supplement coming to Florida with great rates - View
  • Ameritas Dental Plans - The perfect sidekick for your Med Supp sales - View
  • 2018 Choosing a Medigap Policy Guide now available - View
  • More drug discounts available for beneficiaries in the Donut Hole - View
  • 2019 Medicare Advantage / Part D Certifications now available - View
  • 2019 First Looks now available for all major carriers - View
  • 2019 AEP Road Map - Start planning today - View
  • Increase your sales with our complimentary tools and tech - View
  • Express: Mutual of Omaha weekly updates - View
  • VALUES Quote of the Week - View
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Tags: Medicare Advantage plans, Medicare, aetna

Social Security and the Senior Market

Posted by www.psmbrokerage.com Admin on Tue, Jul 31, 2018 @ 03:42 PM

Social Security and the Senior Market

"Social Security Benefits Lose 34% of Buying Power Since 2000, According To Latest Study By The Senior Citizens League"

Social Security and the Senior Market

Social Security remains the most stable retirement pillar for about 85% of the population, yet S.S. benefits have lost 34% of buying power since 2000, says the 2018 Social Security Loss of Buying Power Study.

The findings represent a significant one-year loss of 4% in buying power, with the loss growing from 30% to 34% from Jan. 2017 to Jan. 2018. The loss occurred even though beneficiaries received a 2% annual COLA for 2018.

 

The two expenses that have increased fastest since 2000 are both health care-related:

  • The average monthly Medicare Part B premium increased from $45.50 in 2000 to $134 in 2018 – a 195% increase

  • The average annual out-of-pocket cost for prescription drugs rose from $1,102 in 2000 to $3,172.72 in 2018 – a 188% increase

The average retired worker’s Social Security benefit is $1,412.14 per month in 2018, or $16,945.68 per year, just $4,805 above the poverty line.

Read the full article here

Top-10-Fastest-Growing-Senior-Costs-2

Source

Additional Updates:
  • Thrivent Medicare Supplement coming to Florida with great rates - View
  • Ameritas Dental Plans - The perfect sidekick for your Med Supp sales - View
  • 2018 Choosing a Medigap Policy Guide now available - View
  • More drug discounts available for beneficiaries in the Donut Hole - View
  • 2019 Medicare Advantage / Part D Certifications now available - View
  • 2019 First Looks now available for all major carriers - View
  • 2019 AEP Road Map - Start planning today - View
  • Increase your sales with our complimentary tools and tech - View
  • Express: Mutual of Omaha weekly updates - View
  • VALUES Quote of the Week - View
  • Current agent incentive trips and contests - View

Tags: Medicare Advantage plans, Medicare, Medicare Supplement, Social Security

Understanding the Difference Between Medicare Advantage Plans and Medicare Supplements

Posted by www.psmbrokerage.com Admin on Mon, Jul 30, 2018 @ 11:54 AM

Understanding The Difference Between
Medicare Advantage Plans and Medicare Supplements

Medicare Advantage VS Medicare SupplementsMedicare Advantage and Medicare supplemental insurance (Medigap) are each intended to enhance the value of traditional Medicare coverage. Understanding how Medicare Advantage and Medicare Supplements operate can help agents determine how to structure, market and support these plans. What are the differences between Medicare Advantage and Medigap insurance, and what does each offer its beneficiaries?

How Medicare Advantage health plans operate

Medicare Advantage plans, or Part C plans, are comprehensive benefit packages offered by private payers and funded by the Medicare program. Medicare Advantage companies may also offer plans that include additional services or benefits to members for a higher premium.

Medicare Advantage uses a benchmark bidding system that awards a private payer a set amount of dollars per beneficiary to provide health plan benefits. Health plan bids for MA funds.

Payers in the MA program can sponsor various types of health plans including HMOs, PPOs, private fee-for-service plans (PFFS), and HMO point of service plans (HMOPOS). HMOPOS plans offer out-of-network services for slightly higher costs.

Medicare Advantage can also sponsor a special needs plans (SNP) that provides focused care for members that are dual-eligible for Medicare and Medicaid, members receiving care in acute settings, and members that have high-cost chronic conditions.

Beneficiaries need to be eligible for Medicare Part A and Part B to enroll in an MA plan. Individuals must also live in the MA plan’s regional area to enroll. Medicare Advantage members may also add Part D coverage to their benefits package, which covers prescription drugs.

How Medicare supplemental insurance plans operate

Medicare supplement insurance, or Medigap plans, are health plans sold by private payers to help cover copays, coinsurance, or deductibles not covered under Medicare insurance. Medicare explains that supplement insurance “fills in gaps for certain healthcare cost.”

Medicare Supplement plans standardized and the benefits do not vary from company to company. The plans are divided into categories with an alphabetic label ( Medigap plans A through N). The below chart shows basic information about the different benefits that Medigap plans cover.

CMS will no longer provide “Medigap C and F” plans by 2020, which are plans that cover extra Part B costs.

Beneficiaries with Medicare Part A and B can enroll in a Medicare Supplement plan, however beneficiaries cannot purchase a Medicare Advantage plan and a Medigap policy at the same time.

What type of consumer is likely to enroll in these plan types?

The most recent demographic data for Medicare beneficiaries shows that total 2018 enrollment reached 59 million beneficiaries as of April 2018.

Twenty-one million Medicare beneficiaries enrolled in either an MA plan or a Medicare supplemental insurance policy. A Kaiser Family Foundation analysis estimates that 19 million beneficiaries are enrolled in MA.

Medicare Advantage and supplemental insurance enrollment is the highest in the Midwestern region of the United States. Minnesota has the highest rate of MA and supplemental insurance enrollment, with 59 percent of the population electing for MA or Medigap coverage.

Enrollees in the Medicare program, and consequently MA and Medigap enrollees, are likely to have several chronic conditions at once.

Medicare’s Chronic Conditions Data Warehouse found that 58 percent of Medicare beneficiaries have hypertension, while 47 percent have hyperlipidemia. In addition, nearly a third of Medicare beneficiaries have been treated for either rheumatoid arthritis (32 percent), ischemic heart disease (28 percent), or diabetes (28 percent).

How to take advantage of growing demand for MA and Medigap

Healthcare companies offering MA plans posted significant profits in the first quarter of 2018. Currently, the Medicare Advantage market is a $187 billion segment of the industry. This is great news for agents currently selling MA plans.

A CMS final rule also allows payers to tailor Medicare Advantage benefits to address the needs of chronic beneficiaries. In addition, Medicare Advantage can help companies generate greater cost savings and improved patient outcomes.

Compared to Medicare fee-for-service, Medicare Advantage was more effective at improving beneficiary outcomes and reducing care costs. Lower costs may leave more profit left over after the bidding process.

Companies that want to maximize their market position within the Medicare Advantage should invest in value-added benefits for their members. Payers could extend preventive care benefits, design more affordable cost sharing for specific services, and help MA members make informed health plan decisions.

The Medigap market has also grown steadily.

About 35 percent of Medicare fee-for-service beneficiaries in 2016 had a Medigap policy. The number of Medigap beneficiaries increased from 12.3 million in 2015 to 13.1 million in 2016, said AHIP.

In 2015, 36 percent of Medicare beneficiaries with a single or combined income of $30,00 or less purchased a Medigap policy to help cover costs. Medigap N plan enrollment grew faster than any other Medigap plan type from 2015 to 2016 and has a promising market presence across the Medicare program.

Medigap payers can position themselves favorably in the Medigap market by investing in technologies that improve customer service with health plans and manage the plan’s medical loss ratio (MLR). Health plans in the Medigap market should also invest in strategies that help target desirable consumers and ensure the right beneficiaries are able to find a Medigap plan.

The growing number of seniors in the US, as well as climbing enrollment numbers, could create a highly successful market atmosphere for agents offering either Medicare Advantage or Medigap policies to their prospective clients.

Source

Additional Updates:
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  • 2019 Medicare Advantage / Part D Certifications now available - View
  • 2019 First Looks now available for all major carriers - View
  • 2019 AEP Road Map - Start planning today - View
  • Increase your sales with our complimentary tools and tech - View
  • Express: Mutual of Omaha weekly updates - View
  • VALUES Quote of the Week - View
  • Current agent incentive trips and contests - View

Tags: Medicare Advantage plans, Medicare Supplement

Medicare Advantage Plans Can Pay for Many LTC Services in 2019

Posted by www.psmbrokerage.com Admin on Wed, May 09, 2018 @ 11:25 AM

Medicare Advantage Plans Can Pay for Many
LTC Services in 2019

The Centers for Medicare and Medicaid Services is getting ready to let Medicare Advantage plan issuers add major new long-term care benefits to their supplemental benefits menus.

Medicare Advantage Plans Can Pay for Many LTC Services in 2019The Better Medicare Alliance, a Washington-based coalition for companies and groups with an interest in the Medicare Advantage  has posted a copy of a memo that shows CMS is reinterpreting the phrase “primarily health related” when deciding whether a Medicare Advantage plan can cover a specific benefit.

Kathryn Coleman, director of the CMS Medicare Drug & Health Plan Contract Administration Group, writes in the memo, which was sent to Medicare Advantage organizations April 27, that CMS will let a plan cover adult day care services for adults who need help with either the basic “activities of daily living,” such as walking or going to the bathroom, or with “instrumental activities of daily living,” such as the ability to cook, clean or shop.

A Medicare Advantage plan could not, apparently, cover skilled nursing home care, or assisted living facility fees. But, in addition to adult day care, a Medicare Advantage plan could pay for:

  • In-home support services to help people with disabilities or medical conditions perform activities of daily living and instrumental activities of daily living within the home, “to compensate for physical impairments, ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization.”

  • Short-term “respite care” or other support services for family caregivers.

  • Making non-Medicare-covered safety changes, such as installing grab bars, that might help people stay in their homes.

  • Non-emergency transportation to health care services. (Plans can already pay for ambulance services for enrollees experiencing medical emergencies.)

The Better Market Alliance says the memo is a form of subregulatory guidance. It’s possible that CMS could revise the guidance, and there’s no indication whether any Medicare Advantage issuers will be in a position to add major LTC benefits to their benefits packages for 2019.

CMS said it would be changing the 2019 Medicare Advantage program benefits uniformity requirements in the preamble to a collection of 2019 Medicare program regulations posted in April.

The Medicare Advantage programs lets insurers offer consumers comprehensive plans that serve as an alternative to traditional Medicare coverage. CMS tries to control current costs, avoid any incentives for patients to get more care, and help patients shop for plans on an apples-to-apples basis by putting tight limits on the benefits the plan issuers can offer.

The Better Medicare Alliance serves many health care providers and provider groups. It also includes many insurance- and benefits-related players, including the National Association of Health Underwriters, the American Benefits Council, and Aetna Inc., Humana Inc., Scan Health Plan and UnitedHealth Group Inc.

Issuers of private long-term care insurance once treated Medicaid and Medicare benefits that “crowded out” private insurance benefits as a serious problem.

In recent years, however, as low interest rates, strict rate increase rules, and actuarial projection problems have reduced private insurers’ participation in the private LTCI market, the private issuers themselves have talked about the need for public-private partnerships.

Source

Additional Updates:
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Tags: Medicare Advantage plans, Medicare Advantage information, long term care, ltc

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.

Source

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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.

RelatedMedicare Advantage cleared to go beyond medical coverage - View

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.

Source

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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

Mutual of Omaha plans to sell Medicare Advantage health plans in 2019

Posted by www.psmbrokerage.com Admin on Thu, Jan 18, 2018 @ 12:31 PM

Mutual of Omaha plans to sell Medicare Advantage health plans in 2019

Mutual of Omaha to Enter Medicare Advantage Market in 2019

I'm sure if you've spent even a short amount of time in the Insurance industry you will recognize the name Mutual of Omaha.

But did you know that Mutual of Omaha will begin selling its first Medicare Advantage health plan in 2019?

Mutual of Omaha will work in cooperation with Lumeris Inc., a St. Louis company that will arrange health provider networks and manage the plans.

It’s a big step for the Omaha-based insurer, which got out of the individual and small-group health insurance business more than a decade ago, although it has sold Medicare Supplement plans since 1966 and is the second-largest source of those plans.

But Medicare Supplement enrollment is declining and Medicare Advantage sales are increasing, said Brad Buechler, a Mutual executive vice president.

Medicare Supplement insurance, also known as Medigap, is sold by private companies to help pay some costs not covered by government Medicare.

Medicare Advantage plans also are sold by private companies but are an alternative to government-run Medicare, providing the traditional coverage plus other benefits.

About one-fifth of Medicare recipients use Medicare Supplement coverage to augment their Medicare plans. About one-third use Medicare Advantage plans, and Kaiser Family Foundation predicts that share to pass 40 percent by 2027.

“The goal here is to ensure that we’ve got all of the interests of all parties aligned through the whole health care delivery value system,” Buechler said.

Between 2001 and 2007 Mutual got out of small-group, individual major and group health insurance, dismantling its health care provider networks.

Lumeris has the expertise to set up new networks of providers that want to practice “value-based” care that depends on good medical outcomes rather than traditional fees for each medical service, Buechler said.

Lumeris also will help identify metropolitan statistical areas — yet to be selected — where the new plans can compete for significant market share, he said.

Mutual, which is likely to count more than $8 billion in revenue this year, will own the plans under the Mutual Medicare Advantage name and will provide brand, marketing and distribution expertise and capital.

Mutual declined to reveal its financial goals for the Medicare Advantage business.

Buechler said the plans will have “narrow” networks, meaning clients will choose from limited numbers of physicians, hospitals and other care providers. Such managed care networks are designed to reduce costs while improving efficiency and medical outcomes.

The two companies expect the first plans to be ready for the Medicare open enrollment period that starts Oct. 15, with advertising leading up to that and plans taking effect Jan. 1, 2019.

Precision Senior Marketing is a proud partner of Mutual of Omaha and we look forward to offer agents another quality Mutual of Omaha product as soon it comes available.

Source: http://www.omaha.com/money/mutual-of-omaha-plans-to-sell-medicare-advantage-health-plans/article_abdb2ae8-fbe4-11e7-b7c4-bb29f4f4e57e.html

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Tags: Medicare Advantage plans, medicare supplement insurance, mutual of omaha

UnitedHealth Group profit jumps beyond estimates

Posted by www.psmbrokerage.com Admin on Wed, Jan 17, 2018 @ 05:13 PM

UnitedHealth Group profit jumps beyond estimates

The insurer surpassed $200B in revenue in 2017, and forecasts more earnings and investment.

UnitedHealth Group on Tuesday reported fourth-quarter earnings that easily beat estimates and vaulted the company over $200 billion in annual revenue for the first time, and said it expects the federal tax overhaul will provide a significant profit boost this year.

The Minnetonka-based health care giant, which is the nation’s largest health insurer, said Tuesday that the tax law in 2018 would increase earnings and cash flow by $1.7 billion, prompting UnitedHealth Group to boost earnings guidance by about 16 percent.

The tax overhaul will result in UnitedHealth Group’s rate falling from about 37 percent to 24 percent, analysts say. The savings will allow for investments in everything from data analytics and digital health to the application of artificial intelligence in delivering health insurance benefits.

“We concluded that our ambitions for better health and a better health system are best achieved through investment in ways that will make health care far more affordable and of far higher quality,” David Wichmann, the UnitedHealth Group chief executive, said during a conference call with investors. It’s too soon to detail the 2019 impact, Wichmann said.

The tax law commentary came as UnitedHealth Group reported fourth-quarter earnings that capped a record year for the company in terms of revenue, with full-year sales growing 9 percent in 2017 to $201 billion.

During the fourth quarter, UnitedHealth Group saw strong growth from its Optum division for health services, where each of three key business units reported year-over-year growth in operating earnings of just over 20 percent, wrote Peter Costa, an analyst with Wells Fargo Securities, in a note to investors. Optum includes a pharmaceutical benefits manager, a business that provides IT and data services to other health care companies and a division for nonhospital health care services.

In December, Optum bolstered its business providing health care directly to patients with a $4.9 billion deal to acquire DaVita Medical Group. With the acquisition, the company says it will have a presence in 35 local health care markets across the country, or nearly half the 75 markets it has targeted for development.

The health insurance business at UnitedHealth Group has been growing, too. At the end of the fourth quarter, the company’s UnitedHealthcare division was providing insurance coverage to about 45.4 million people in the U.S., up from nearly 45 million people at the end of the third quarter.

UnitedHealth Group employs about 18,000 people in Minnesota. Historically, the company has had only a minimal presence in Minnesota’s health insurance market, but UnitedHealthcare officials last year said they have plans for selling more coverage to employer groups in the state.

During Tuesday’s conference call, a company official said the push into Minnesota and the northern plains would come in the second half of 2018.

UnitedHealth Group closed 2017 with not just with the DaVita Medical Group deal, but also an agreement to acquire a health care provider and insurer operating in Chile, Colombia and Peru for roughly $2.8 billion. In 2012, the company acquired the largest hospital operator and health insurer in Brazil.

“Collectively, these countries have a population roughly equal to that of the U.S., but perhaps more growth opportunity in these emerging private health care markets, as well as a broader and longer term opportunity to serve the systems more holistically by also serving public markets,” said Molly Joseph, chief executive of UnitedHealth Group’s international business.

The deal to acquire Empresas Banmédica is expected to close in the first quarter. Wichmann said UnitedHealth Group had been studying the South American markets for about five years.

In December, President Donald Trump signed legislation that significantly reduces the tax rate on corporations including UnitedHealth Group. The savings result in reduced premium revenue and certain fees for UnitedHealth Group, due in part to increased consumer rebates triggered by regulation on the share of UnitedHealthcare premium revenue that’s directed to medical costs.

Even after adjusting for the estimated $400 million to $500 million hit on premiums and fees, UnitedHealth Group expects the law to benefit earnings and cash flow by $1.7 billion.

In addition, the tax law savings will allow for an additional $200 million to $300 million investment to reduce operating costs by accelerating “existing initiatives in artificial intelligence, data analytics, individual health record custodianship, digital health ... [and] more health-related initiatives in local communities,” Wichmann said.

“We expect to invest the remaining increased cash flows to better fulfill our mission and, in turn, to grow and diversify our enterprise,” he said.

For the fourth quarter, UnitedHealth Group saw net income more than double, to $3.6 billion, on $52 billion in revenue.

After excluding one-time items, earnings per share of $2.59 beat the $2.52 expected among analysts surveyed by Thomson Reuters. Benefits from the tax bill did not affect the quarterly earnings per share calculation, the company said.

“We revalued our U.S. deferred tax liabilities to reflect the newly enacted federal statutory rate of 21 percent, which added $1.2 billion in noncash earnings in 2017,” said John Rex, the company’s chief financial officer, during the conference call.

UnitedHealth Group says it now expects in 2018 adjusted earnings of $12.30 to $12.60 per share, up from a November forecast of $10.55 to $10.85. The company expects 2018 revenue in the range of $223 billion to $225 billion.

UnitedHealth Group shares closed Tuesday at $232.90, up nearly 2 percent for the day.

Source: http://www.startribune.com/unitedhealth-group-profit-jumps-beyond-estimates/469526733/

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