There will be somewhat fewer plans to pick from this year, but in general people will have plenty of options, experts say. And although premiums aren’t expected to rise markedly overall in 2015 - and in some cases may actually decline - some individual plans have signaled significantly higher rates. Although the Centers for Medicare and Medicaid Services has released some specifics about 2015 premiums and plans, many details about provider networks, drug formularies and the like won’t be available until later this fall. Here’s what we know so far about Part D and Medicare Advantage.
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With looming deadlines of October 15, for Medicare’s traditional open enrollment date, and the overlap of the first enrollment period for Patient Protection and Affordable Care Act set to start on October 1 – December 7, has caused a lot of confusion among seniors over their coverage.
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The chief executive of Avalere Health, Dan Mendelson, explains that even in cases when switching Part D plans is the most economical option, seniors are still more reluctant to do so. Yet, due to repercussions from health-care laws, there are some changes to the Part D program and it is important to have senior's evaluate their options so they can be assured they are on the best plan for their prescriptions. A new plan from Humana's Wal-Mart-Preferred Rx Plan boasts a $14.80 premium in all regions; however, premiums not only depend on cost but also deductibles, coinsurance, and doughnut hole coverage. Specific details of the Part D plans will be released in time for Annual Enrollment, on November 15th.
Setting New Medicare Skilled Care Service Standards
Two federal courts ruled that the standards for Medicare coverage of skilled nursing home care or home health care are too strict. Before this ruling, Medicare would only pay if a patient's condition would get better with the service, mistaking the belief that Medicare will only pay if treatment makes the patient "better." In correlation with the federal court's ruling, Medicare will now pay for the service if it is needed in order to maintain routine activities in daily life or to prevent the condition from getting worse. This is most significant for those patients with multiple sclerosis, Alzheimer’s disease, and a broken hip who need skilled care to assist them in their daily life.
Medicare Cuts Payments on Prostate Cancer Therapy
In order to curb inappropriate use and save health-care money, Medicare has begun paying physicians less for common prostate cancer therapy. A University of Texas study evaluated how many times adfrogen deprivation therapy was prescribed both before and since the Center for Medicare and Medicaid lowered the reimbursement rates. They found that there was no change in those who needed the treatment; however, it was prescribed 30% less in those who showed no beneficial medical evidence of needing it. These reduced reimbursements caused a positive change in health care by limiting the unnecessary care and driving a new pattern of care. Also, in this prostate cancer therapy case, negative side effects also contributed. Thus, there were both clinical and financial benefits.
Supplier Bidding Contracts Announced
On Thursday the Centers for Medicare and Medicaid Services announced the 356 suppliers who won contracts to provide durable medical equipment for nine areas around the country. With 1,217 contracts signed and 356 suppliers set to produce, prices will be cut by 32% saving a projected $28 billion over the next 10 years. The new program begins in January in Charlotte, Gastonia, Concord, Cincinnati, Middletown, Cleveland, Elyria, Mentor, Dallas, Fort Worth, Arlington, Kansas City (MO & KS), Miami, Fort Lauderdale, Pompano Beach, Orlando, Kissimmee, Pittsburgh, Riverside, San Bernardino, and Ontario. Though, a House bill to repeal the program has attracted 250 sponsors.
Woodmen Plan N Released in LA and AZ
Sources: KHN, The LA Times, The Hill, National Journal
After December 31, 2010 a new health law goes into effect prohibiting physician-owned hospitals opening after that day from taking part in Medicare and other federal health programs. Whereas 30 hospitals are expected to open before the deadline, 44 will be unable to open in time; and, in some cases doctors will have to sell their stakes in order to open. Not only are there restrictions on the hospitals being built, but also on expansions. Some conditions that will be considered for new or expanding physician-owned hospitals are that the hospital is located in a state with a shortage of hospital beds, in a county that is showing growth 50% faster than the rest of the state, or seeing more Medicaid patient than other hospitals in their county. It has been suggested that very few hospitals will be able to meet these requirements. This new law stems from non-profit community hospitals and for-profit institutions without physician investors believing physician-owned hospitals are taking all of the lucrative outpatient surgery. In 2003 there was a moratorium placed on the construction of physician hospitals that lasted until August 2006; and, denying access to Medicare and federal health program funding is the newest attempt to suppress physician-owned hospitals.
Democrats' Projected Bad Election Year
A poor performance by Democratic Party members is expected due to the party's signature health care law, even in states that have voted Democratic predominately. A Battleground Poll shows that 54% of people are opposed to the health care law with 40% of those are strongly opposed, some favoring a repeal of the law. Participants polled by the National Republican Congressional Committee said the issue affecting their vote against the current member of Congress in their district was health care, surprisingly over the economy and jobs. The focus on health care by the administration came at the worst possible time and midterm election projections show Democrats who voted for the law not doing well at all. Especially the Democrats who voted as the decisive margin - the Stupak bloc - who are currently most at risk. The health care law is affecting both House and Senate Democratic members and the White House needs to address the opposition to the law. Or, they need to at least prepare for it, as Republicans elected plan to repeal at least part of the legislation when and if they are elected into office this November.
Paul Ryan's Generation of Conservative Leaders
Republican Paul Ryan, Wisconsin, wrote the book Young Guns: A New Generation of Conservative Leaders with Eric Cantor of Virginia and Kevin McCarthy of California, also Republicans in the House of Representatives. Ryan explains that Medicare is not supported well and needs help in order to continue its existence. In the book, the authors propose that those 55 or older will get Medicare as it is today, but for everyone else Medicare will start at 69 1/2. In their plan, a Medicare payment for the purchase of private health coverage would be distributed. To start the vouchers would cover $11,000 and they would increase with inflation. If beneficiaries have any money left at the end of the year, it will go into a medical savings or go toward long-term care insurance. Additionally, the payment amount would also depend on income, health status, and initially region with those earning under $80,000 a year receiving the full benefits. The midterm reelection gives them position to propose their ideas, if Republicans get control of the House, and protesters set up rallies to warn seniors about these issues before they vote.
November is Around the Corner
Are you ready for this year's Annual Enrollment? Monday is November 1st, and with only a few days left before Annual Enrollment starts on the 15th, make sure you contact Precision Senior Marketing to add all of the best Medicare Supplement products to your portfolio. From Forethought and Gerber Life to Woodmen of the World/Assured Life, Sentinel Life, and United of Omaha, we have the Medicare Supplements your clients are looking for. Give PSM a call at 1-800-998-7715 and enjoy a profitable Annual Enrollment season!
Sources: KHN, USA Today, The Hill, National Journal
Medicare's chief actuary, Rick Foster, projects the new Health Care law savings of $575 comes from slowing the increase in fees paid to hospitals, home health agencies, and reducing payments to private Medicare Advantage plans. The new Health Care law does slow the growth of Medicare; but, does not cut spending from year to year over the next decade. In fact, no benefits under traditional Medicare will be eliminated and some will be added. The biggest impact will be on the roughly 24% of seniors on Medicare Advantage who will see extra benefits on their plan eliminated and some plans shut down all together. Seniors are concerned about finding new doctors, if and when they have to, and some doctors are refusing new Medicare patients because Medicare doesn't pay enough. Plus, a 1997 law beginning December 1, reduces doctors' Medicare payments even more causing concern. The law also adds new benefits to Medicare including free preventive screenings and $250 rebates to those seniors who hit the "doughnut hole" of prescription drug coverage and the changes will keep the Medicare hospital trust fun afloat until 2029, which is twelve years longer than projected without the law. Most speculate that Congress will postpone these law from going into effect.
Choices in Medicare Advantage Plans Equal Less Confusion
In 2011, Medicare Advantage premiums and Medicare Part D prescription drug packages will rise approximately 5% from 2010. One reason for the rise in cost is that there will be fewer options in Medicare Advantage. Some senior advocates say seniors were confused in the past by too many options and therefore some ended up making ill-informed decisions out of frustration. Joe Baker, president of the Medicare Rights Center says "People still have good choices, but they also have less choice, which makes it easier to choose." With the lowest cost prescription drug plan being offered from Humana and Wal-Mart Preferred RX, Baker also warns not to be too swayed by price and to make sure all drugs are covered on the approved list with no restrictions. Seniors have from November 15th to December 31st to decide on a new plan.
Forethought® Medicare Supplement Product Release
This week, the Forethought® Medicare Supplement product was released in Iowa, Louisiana, Mississippi, Ohio, Oklahoma, South Carolina, and West Virginia. Forethought Benefits Include:
Mutual of Omaha offers Seminar Packages
Just in time for Annual Enrollment, Mutual of Omaha is offering a point-of-sale seminar package including a PowerPoint presentation, speaker notes, and an invitation flyer or postcard to send to invite perspective attendees. States that have already approved the package include AR, AZ, CT, DC, GA, HI, IA, IL, IN, KS, KY, LA, MI, MN, MO, MS, NC, NE, NJ, NV, NY, OH, OK, OR, RI, SC, SD, TN, UT, VA, VT, WI, and WV, with new states being approved continuously. The seminar package was created to help attract and educate groups of new prospects about the advantages of owning a Medicare Supplement, reasons to own a Mutual of Omaha Medicare Supplement, and a brief history of Mutual of Omaha. Materials are currently available under your Sales and Professional Access (SPA) account at Mutual of Omaha in the Forms and Materials section. For more information about getting contracted to sell Mutual of Omaha Medicare Supplement, click here.
Sources: KHN, The Washington Post, The Tennessean, Mutual of Omaha
As many of you already know, Medicare's Annual Open Enrollment begins November 15 and will last until the end of the year December 31. The Centers for Medicare & Medicaid Services this week released the final $6.3 million of a total $49.6 million in total funding allocated for State Health Insurance Assistance Programs (SHIPs).
SHIPs use this money to fund local community programs that provide personalized help to Seniors who want to know more about Medicare and other health insurance information. SHIP programs are expected to focus heavily on less fortunate Seniors who typically have little knowledge of the Medicare system and the benefits they are entitled to. For more information on the SHIPs in your state, click here.
For this open enrollment season many in the industry expect to see an increase in Medicare supplement enrollments due to several changes to Medicare Advantage that will occur in 2010. MA beneficiaries can expect to see an average premium increase of nearly 22% (a $7 increase to $39/month). Despite the increases, CMS states that roughly 87% of Medicare beneficiaries will still have access to a MA plan that doesn’t require a premium. Additionally, CMS expects 7% of MA beneficiaries will have to choose a new health plan or a Medicare supplement as their plans (typically PFFS and low enrollment plans) will be discontinued at the end of this year.
CMS will also increase its oversight of Medicare marketing activities. There are now stronger rules governing the commissions that can be paid to independent sales agents and how MA plans identify themselves. CMS will significantly increase its secret shopping activities, including individual marketing sessions. So we advise that you be extra vigilant in your compliance efforts this season. Mutual of Omaha has already published its disenrollment guidelines, which you can check out here.
As usual, Seniors will have access to www.medicare.gov and 1-800-MEDICARE this season. Of course, these are good resources for agents such as yourself, if only to ensure that your information aligns with the official source. For all open enrollment related information, click here.
As always, we’ll keep you updated with the latest news and product information to help make this open enrollment season a successful one for your organization.
Sources: CMS, Senior Journal
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