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Center for Medicare Advocacy Releases Analysis of Various Medicare Advantage Changes
This week, the Center for Medicare Advocacy (CMA) released an issue brief that examines the details and legal underpinnings of several proposed and upcoming changes to the Medicare Advantage (MA) program. Designed to be a resource for advocates and attorneys, CMA’s analysis combines several disparate sources of MA changes, including recently signed legislation, regulatory rulemaking, and sub-regulatory guidance. It also predicts some of the consequences of these changes on, among other things, beneficiary decision-making and informed choice. The brief outlines the changes to MA made in the Balanced Budget Act of 2018 (BBA), in the Part C and D final rule issued earlier this year, and in the Final Call Letter for 2019. These changes increase flexibility for MA plans in several ways, including:
With so many significantly overlapping changes, this report provides a comprehensive and thorough analysis – listing together the various flexibilities and freedoms MA plans will have in the coming years. Medicare Rights continues to monitor and analyze how these regulatory trends and practical changes will affect people with Medicare and those who help them navigate coverage decisions. As part of this process, we will be releasing consumer-friendly education tools and policy analysis in the coming weeks on the anticipated changes to MA plans, beneficiary tools and resources, Medicare and the opioid crisis, and Medicare enrollment periods. We also remain actively engaged in the implementation of these regulatory developments, to ensure the beneficiary perspective is considered and embedded in any changes to the program. We recognize that some of the new policies may not ultimately benefit people with Medicare, and we will continue to monitor the use and potential abuse of these new rules. |
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CMS Expands Benefit Flexibility In Beginning in 2019, MA plans can leverage the new flexibility to partner with community-based organizations to create services aimed at addressing barriers to access to care or avoiding costly care. The major new flexibilities for 2019 and beyond include: Benefit Uniformity Flexibility: In 2019, MA plans can design disease-specific benefits for individuals with certain chronic conditions or other high-risk health conditions if 1) they are available to all enrollees, 2) MA plans use objective and measurable medical criteria, and 3) beneficiaries’ diagnoses have been certified by a provider... Supplemental Benefits: The previous “primarily health-related” definition has been expanded for supplemental benefits to permit coverage of services to diagnose, prevent, or improve the effects of injuries or health conditions, or reduce avoidable emergency healthcare utilization... |
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Tags: medicare advantage updates, New Med Advantage Rules, medicare updates
Medicare Agent Broker Compensation Rate Adjustment - Medicare Advantage Contract Year 2019This memorandum provides contract year (CY) 2019 compensation limits for agents and brokers, directions for submitting amounts into the Health Plan Management System (HPMS), as well as training and testing requirements. Compensation Rate Adjustment for CY 2019
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Tags: medicare advantage updates, medicare updates, Medicare Open Enrollment Period, OEP
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We are excited to tell you more about this opportunity! Give our Marketing Team a call at 800-998-7715 for more information! Now is a great time to review carrier expansions and incorporate them into you 2019 AEP marketing plans. |
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Tags: medicare advantage updates, aetna, medicare updates, Medicare Open Enrollment Period, OEP
Medicare Open Enrollment Period (OEP)
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Tags: medicare advantage updates, medicare updates, Medicare Open Enrollment Period, OEP
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 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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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. Tags: medicare advantage updates, Medicare Advantage, Medicare Advantage News, medicare advantage enrollment,, ma enrollment,
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PSM has received the 2015 proposed benefits for two of our top MA-PD carriers. Aetna / Coventry and UnitedHealthcare®. Both companies are offering strong offerings for 2015 with many zero premium areas. Contact us today to make sure you have these companies in your portfolio for the upcoming Enrollment window. Request DetailsSource: psmbrokerage.com |
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Tags: medicare advantage updates, medicare advantage 2015 updates, medicare advantage rates 2015