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Medicare Blog | Medicare News | Medicare Information

CMS rule gives Medicare Advantage plans an edge over traditional Medicare

Posted by www.psmbrokerage.com Admin on Thu, Apr 04, 2019 @ 09:52 AM

man on mountain

 

The Centers for Medicare and Medicaid Services today finalized payment updates to Medicare Advantage and Part D plans for 2020.

MA rates increase 2.53 percent. This includes the phasing-in of a risk adjustment model that takes into account the number of chronic conditions a person has, according to CMS Administrator Seema Verma.

CMS originally had released a rate increase of 1.59 percent.

The effective growth rate increased from 4.59 percent in the advance notice, to 5.62 percent today. Verma said the reason for the change is that CMS is continually updating information.

However, the biggest changes for Medicare Advantage insurers is in their ability to offer additional, non-health benefits to members who have a chronic condition, if there is a reasonable expectation of improving or maintaining the health or overall function of the enrollee. Plans can address the social benefits of health in these tailored benefits.

For example, beneficiaries could now receive transportation for non-medical needs like grocery shopping and home environment services to cover home air cleaners and carpet shampooing for asthma sufferers.

WHY THIS MATTERS

Today's supplemental benefit flexibility gives Medicare Advantage plans an edge in competition over traditional Medicare fee-for-service.

The flexibility in today's rule is due to legislation in the Bipartisan Budget Act, Verma said.

Asked why Congress would allow MA plans to have an edge in offering benefits over traditional Medicare fee-for-service, Verma said fee-for-service is an open-ended benefit program while MA is capped and is a value-based payment systems. CMS supports allowing the flexibility for plans to address the social determinants of health in a value-based arrangement, she said.

The varying benefits are also expected to spur competition between MA plan offerings.

Medicare Advantage is a growing program both for seniors and for insurers, with CMS not-so-subtly promoting the private health insurance option.

Average Medicare Advantage premiums are at their lowest in six years, Part D premiums are at their lowest in three years, and plan choices have increased, CMS said today.

WHAT ELSE YOU NEED TO KNOW

CMS calculates risk scores using diagnoses submitted by Medicare fee-for-service providers and by MA organizations.

CMS is including encounter data in  calculating the risk scores despite objections by some stakeholders. For 2020, CMS will blend 50 percent of the risk score calculated using diagnoses from encounter data, the RAPS Risk Adjustment Processing System inpatient diagnoses and FFS diagnoses, with 50 percent of the risk score calculated with diagnoses from RAPS and FFS.

For 2020 CMS expects the underlying coding trend to increase risk scores, on average by 3.3 percent.

PART D

The payment and policy updates include actions to address the opioid crisis,  encouraging Part D plans to provide at least one opioid-reversal agent on a lower cost-sharing tier.

CMS said its overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).

TREND

Starting this year, Medicare Advantage plans could offer supplemental benefits that are not covered under Medicare Parts A or B, such as adult day health services, and/or in-home support services under an expanded definition of supplemental benefits.

The updates released today continue the Trump administration's efforts to increase competition among Medicare Advantage and Part D plans. CMS said.

ON THE RECORD

"Today's changes give plans the ability to be innovative and offering benefits and services that address social determinants of health for people with chronic disease," Verma said. "With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that they focus on preventing disease and keeping people healthy." 

Source: https://www.healthcarefinancenews.com/news/cms-rule-gives-medicare-advantage-plans-edge-over-traditional-medicare

Photo by eberhard grossgasteiger from Pexels

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Tags: Medicare Advantage, Medicare Part D

No Donut Hole, But Drug Costs Still Bite

Posted by www.psmbrokerage.com Admin on Tue, Apr 02, 2019 @ 03:54 PM

No Donut Hole, But Drug Costs Still Bite

donut hole.jpg

By the Kaiser Family Foundation – March 29, 2019

The 2006 introduction of the Medicare prescription drug benefit was a boon for seniors, but the coverage had weak spots. One was the so-called donut hole – the gap beneficiaries fell into after they accumulated a few thousand dollars in drug expenses and were on the hook for the full cost of their medications. Another was the lack of an annual cap on drug spending. Legislative changes have gradually closed the donut hole so that, this year, beneficiaries no longer face a coverage gap. But there’s no limit for prescription medications in Part D. With the cost of specialty drugs increasing, some Medicare beneficiaries could owe thousands of dollars in out-of-pocket drug costs every year for a single drug. Recent proposals by the administration would address the long-standing problem by imposing a spending cap. But it’s unclear whether any of these proposals will gain a foothold.

Read more.

Source: https://khn.org/news/doughnut-hole-is-gone-but-medicares-uncapped-drug-costs-still-bite-into-budgets/

Image: Freepik

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Tags: Medicare Part D

Continued Year-Over-Year Medicare Advantage and PDP Membership Increases

Posted by www.psmbrokerage.com Admin on Tue, Apr 02, 2019 @ 02:42 PM

Continued Year-Over-Year Medicare Advantage and PDP Membership Increases

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The Annual Election Period (AEP) for Medicare Advantage (MA) and prescription drug plans (PDPs) runs each year from October 15th through December 7th.  Health companies compete by offering new pricing and product options to beneficiaries during the AEP.  Plans then begin to analyze final enrollment results in February and March to evaluate their standing and assess which competitors gained and lost members during the last AEP. 

Many companies conduct their post-AEP competitive assessments by using tools such as Mark Farrah Associates’ (MFA) Medicare Business Online™ and Health Coverage Portal™.  As of March 1, 2019, total Medicare Advantage, including Medicare Advantage with Prescription Drug Plan (MA-PD) membership stood at 22,654,276 with a net gain of 1,554,366 members, year-over-year.  Medicare stand-alone prescription drug plans (PDPs) covered 25,559,801 members as of March 1, 2019, a gain of 38,835 from the previous year.  This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2019.

MA Enrollment Growth by State

MBO MA Map

Click here to read more. 

Source: https://www.markfarrah.com/mfa-briefs/continued-year-over-year-medicare-advantage-and-pdp-membership-increases/

Image: Freepik

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Tags: Medicare Advantage, Medicare Part D

What Beneficiaries Want in a Medicare Plan

Posted by www.psmbrokerage.com Admin on Wed, Feb 20, 2019 @ 02:18 PM

What Beneficiaries Want in a Medicare Plan

By eHealth – February 20, 2019

Medicare beneficiaries love their coverage and think more Americans should have access. Only 6% express dissatisfaction with their Medicare coverage; 41% say that all Americans should have Medicare-like coverage (an increase from 34% since last August); an additional 11% say that at least people age 55 and older should be eligible for Medicare. A new report from eHealth defines what beneficiaries find most important in their Medicare Plans.

blog chart 2-20-2019
Source: https://www.prnewswire.com/news-releases/ehealth-survey-reducing-prescription-drug-costs-seen-as-key-to-ensuring-medicares-future-300797020.html

To read the full report, click here.

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Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D

Humana expects more than 700K will drop out of Part D plans as market competition heats up

Posted by www.psmbrokerage.com Admin on Wed, Feb 06, 2019 @ 03:15 PM

Humana expects more than 700K will drop out of their Part D plans


By Paige Minemyer – FierceHealthCare – February 6, 2019

Humana is expected to bleed a significant number of members from its Part D plans, as greater competition has chipped away at the company’s market share. 

Brian Kane, Humana’s chief financial officer, said on the company’s earnings call Wednesday morning that the insurer expects to lose between 700,000 and 750,000 members in its stand-alone Medicare prescription drug plans in 2019. That is a decrease in projections from November, when Humana estimated that as many as 800,000 people could drop from its Part D rolls. 

As more competitors have entered the Part D market, Humana’s plans are no longer consistently the lowest cost, which is leading some members to switch to other insurers, Kane said. Humana is now working to “innovate” the value proposition in their plans. 

“While it will take time, we intend to stay competitive,” CEO Bruce Broussard said. 

Though Humana expects a downturn in enrollment in its Part D plans, it is still projecting about 4.5 million enrollees in those plans, according to its earnings documents. 

Policy changes in Part D add another wrinkle to this discussion, Kane said, but Humana is rethinking its approach in that market irrespective of how proposals play out. 

That said, should the Department of Health and Human Services finalize its plan to end drug rebate protections in Part D for the 2020 plan year, that change would be “material” and would have significant implications for how these plans function, he said. 

The biggest risk, he said, is a potential adverse selection in pricing if the approach to negotiation is fundamentally changed. In addition, Humana is also concerned that the policy change is likely to drive up premiums in Part D plans. 

Though Humana reported a downturn for enrollment in its Part D plans, its Medicare Advantage business was a bright light in 2018 and is a key source of the company’s momentum heading into the 2019 fiscal year. 

Medicare Advantage a bright spot

Humana reported a 6% increase in revenue for 2018, reaching $56.91 billion compared to $53.77 billion in 2017. Fourth quarter revenues were also on the rise, totalling $14.07 billion, a 7% uptick from $13.10 billion in Q4 2017.

As the health insurance fee was pushed off to 2020, Humana was able to invest significantly in improved service for its MA plans, Broussard said. The Centers for Medicare & Medicaid Services set strong rates for MA in the 2019 plan year, as well, he said, so that growth is expected to continue this year.

Humana expects to add 370,000 to 400,000 seniors to its MA plans in 2019, increasing its membership by 12% to 13%. Kane said the company also expects to add about 30,000 people to its group Medicare Advantage plans. 

“We are pleased with the consistency of ongoing improvement in our performance,” Broussard said.

Source: https://www.fiercehealthcare.com/payer/humana-expects-more-than-700k-will-drop-out-part-d-plans-as-market-competition-heats-up

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Tags: Humana, Medicare Advantage, Medicare, Medicare Part D

The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019

Posted by www.psmbrokerage.com Admin on Thu, Jan 31, 2019 @ 10:57 AM

The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019

By the Kaiser Family Foundation – January 30, 2019

Part D made prescription drugs more affordable for Medicare beneficiaries, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Part D enrollees not receiving low-income subsidies can expect to pay thousands of dollars OoP for a specialty tier drug in 2019: median annual OoP costs in 2019 for 28 of the 30 studied specialty tier drugs range from $2,622 for Zepatier (hepatitis C) to $16,551 for Idhifa (leukemia). Not all specialty tier drugs are covered by all Part D plans, unless they are in one of the six protected classes (such as cancer drugs). 

untitled grid blog

 In 2019, annual out-of-pocket costs are 12% higher than in 2016, on average.

ARTICLE

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Tags: Medicare, Medicare Part D

Medicare’s New “What’s Covered” App

Posted by www.psmbrokerage.com Admin on Thu, Jan 31, 2019 @ 10:27 AM

Medicare’s New “What’s Covered” App

The CMS released a new app yesterday that describes what Medicare will cover, part of CMS’s plan to help beneficiaries decide between coverage options. The What's Covered app will let users see whether Medicare covers a specific item or service.


The app delivers general cost, coverage and eligibility details for items and services covered by Part A and Part B. Search or browse to learn what’s covered and not covered; how and when to get covered benefits; and basic cost information. You can also get a list of covered preventive services and Medicare Advantage options.

Article

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  • MA plans face "Land Grab" year, focus on benefits in 2019 - View
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Tags: Medicare Advantage, Medicare, Medicare Part D

Medicare Advantage Plans Face ‘Land Grab’ Year, Focus on ‘Sizzle’ Benefits in 2019

Posted by www.psmbrokerage.com Admin on Tue, Jan 29, 2019 @ 11:29 AM

MA Plans Face ‘Land Grab’ Year, Focus on ‘Sizzle’ Benefits in 2019


By Judy Packer-Tursman – AIS Health – January 28, 2019

Opportunities for managed care plans abound in Medicare Advantage (MA), the popular, competitive program that seems to enjoy bipartisan support, experts tell AIS Health.

The bottom line is, “The [MA] payment rate seems OK, and there will be a lot of innovation, heavy advertising, more vertical integration,” says Stephen Wood, managing partner at Clear View Solutions, LLC. “It’s still a very robust market…and the Medicare population is growing by leaps and bounds.”

Wood, along with his partner, Kirk Twiss, describes the MA environment as “market consolidation at the top — with some states virtually dominated by two or three carriers, a few ‘ankle biters,’ and that’s it — and fragmentation, growth and specialization at the bottom.”

The latter includes local provider-sponsored startups trying to launch specialized MA products, he says. But he notes that such startups face fundamental challenges: gaining sufficient enrollment and having enough revenue to cover administrative expenses. Moreover, Twiss points out, it’s “hard to compete against national plans with so many resources.”

With MA bids for next year due in early June-1On the Medicare Part D side, much remains in play, Twiss notes. Due to industry consolidation and vertical integration, there won’t be independent PBMs, he says, and issues surrounding prescription drug rebates, Part D benefit design and drug pricing are all unresolved.

With MA bids for next year due in early June, Brad Piper, principal and consulting actuary for Milliman, Inc., says “In my mind, flexibility was probably one of the key drivers [of MA] in 2019, and I think we’re going to see that still in 2020.”

The Medicare Advantage program, by including more flexibility on supplemental benefits, is allowing what Piper calls “enticement” benefits. In addition to fitness, dental, hearing and vision benefits, plans increasingly are offering a benefit to help members purchase over-the-counter health-related items, he says, and transportation to the doctor’s office is becoming more popular.

Wood describes them as “sizzle” benefits that are “more marketing oriented than clinically oriented.” He says companies continue to assess how to deliver such benefits and develop solid 2020 bids containing them by the June deadline.

What does the future hold for MA? “At least for the next year, it’s all good news,” Twiss says. “Beyond that, things change very quickly in the health care business.”

Source: https://aishealth.com/medicare-and-medicaid/ma-plans-face-land-grab-year-focus-on-sizzle-benefits-in-2019/

Image: Freepik

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Tags: Medicare Advantage, Medicare, Medicare Part D

Medicare Announces New Model to Test Changes to Part D Payments

Posted by www.psmbrokerage.com Admin on Tue, Jan 29, 2019 @ 10:34 AM

Medicare Announces New Model to Test Changes to Part D Payments


This week, the Centers for Medicare & Medicaid Services (CMS) announced a new model to test changes to prescription drug payments and incentives. The CMS Center for Medicare and Medicaid Innovation (CMMI) will create a voluntary, five-year model in which Part D Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MAPDs) may apply to participate.

According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”

Read More

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Tags: Medicare, Medicare Part D

Mutual of Omaha: MA and PDP Compensation Payments

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 08:40 AM


The following is information regarding the payment of compensation for Mutual CareAdvantage (HMO) (MA) and Mutual of Omaha Rx (PDP) sales.

 
Medicare Advantage Compensation

  • Payment will be made beginning January 2019
  • Compensation Schedules – can be found on Sales Professional Access (SPA), click on the Profile icon in the upper righthand corner.  Choose Communications and filter on company – Mutual of Omaha Medicare Advantage Company and access your contract packet which includes your compensation schedule. 
  • Compensation Statements -  can be found on the Medicare Advantage producer portal by clicking on the ‘Commission’ icon. A link to the portal is found on the Medicare Advantage product page on Sales Professional Access (SPA) mutualofomaha.com/broker.  
  • For questions:
  • Click for details regarding MA compensation.

 Prescription Drug Plans Compensation

  • Payment will begin April 2019
  • Compensation Schedules – Can be found on Sales Professional Access (SPA), click on the Profile icon in the upper right hand corner. Choose Communications and filter on company – Omaha Health Insurance Company and access your contract packet which includes your compensation schedule. 
  • Compensation Statements - can be found on Sales Professional Access (SPA) under Reports beginning in April.
  • For questions:
  • Click for details on PDP Compensation

Not appointed to sell Mutual of Omaha PDP plans? Request details here

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Tags: Medicare Advantage, Medicare Part D, mutual of omaha

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