Medicare Advantage plans may not be all they’re cracked up to be and often mislead consumers, according to a new MedPage Today story by reporter Cheryl Clark, who also is AHCJ’s new patient safety core topic leader. As Clark puts it, “getting out is a lot harder than getting in.”
Anyone turning 65 has several months on either side of their birthday to choose to enroll in traditional Medicare, the government-run health insurance for older adults and certain people under 65 with disabilities. Medicare includes Parts A (hospitalization), B (physician services) and an optional Part D (prescription drug plan). As of November, Medicare covered nearly 39 million people. Continue reading
This post was co-written by Joseph Burns (@jburns18), a Massachusetts-based independent journalist and AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at firstname.lastname@example.org.
You may have seen the April 2 press release from the Centers for Medicare and Medicaid Services that highlighted the steps it is taking to, among other efforts, advance a more patient-centered approach, reinterpret standards for supplemental benefits under Medicare Advantage plans, lower prescription drug prices and address the opioid crisis. While that’s a lot to promise in a page and a half, more details are available in CMS’ 2019 Medicare Advantage and Part D Rate Announcement and Call Letter. Be forewarned, however, that many journalists may need experts to interpret the implications of what CMS calls its call letter. Continue reading
A federal review of health insurers operating Medicare Advantage plans shows that 35 health plans overbilled the federal Centers for Medicare & Medicaid Services, the Center for Public Integrity reported on August 29.
Fred Schulte, a CPI senior reporter, said the center obtained 37 MA plan audits through a Freedom of Information Act lawsuit. The documents indicated that 35 of those health plans were overpaid in 2007. The typical overpayment was several hundred thousand dollars.
“Among the insurers charging the government too much: five Humana, Inc. health plans, three UnitedHealth Care Group plans and four Wellpoint, Inc. plans,” Schulte wrote. None of the plans would comment for Schulte’s article. Continue reading
Medicare Advantage enrollment is soaring, defying expectations after $150 billion in spending cuts over a decade that were part of the Affordable Care Act. The Congressional Budget Office expected about a 30 percent falloff – but enrollment has risen by 50 percent to more than 17 million people.
The ACA exchange enrollment is way under expectations. About 12.7 million people signed up this year – and not all will pay their premiums and stay enrolled. The CBO had forecast 21 million for this year. Continue reading
Source: B. Biles, G. Casillas, and S. Guterman, “Competition Among Medicare’s Private Health Plans: Does It Really Exist?” The Commonwealth Fund, August 2015.Click to enlarge.
Anyone examining health insurance competition should look closely at a new report from the Commonwealth Fund, which indicates competition among Medicare Advantage (MA) plans is so rare that only one county studied is considered to not have a highly concentrated MA market.
After reviewing enrollment data in all U.S. counties with at least 10 residents enrolled in Medicare Advantage plans, the report, “Competition Among Medicare’s Private Health Plans: Does It Really Exist?,” said that in the 100 counties with the most MA members, market power is concentrated among three big insurers in almost two-thirds of those counties. Continue reading
Between now and Oct. 15, when open enrollment begins for Medicare Advantage, health insurers are likely to drop some of their MA plans. Last month, MVP Health Care in Schenectady, N.Y., dropped two of its five MA plans, saying it could no longer afford to offer them.
When health insurers drop these plans, they are likely to leave questions unanswered, as MVP did. Gretchen Jacobson, an associate director with the Kaiser Family Foundation’s Program on Medicare Policy, suggests some questions health care journalists might want to pursue, such as:
- What are the quality scores (called star ratings) for the plans being dropped?
- In which counties do MA plan members live?
- How did the negotiations go with physicians, hospitals, and other providers serving members in the plans being dropped?