Medicare To Cut Payments To Medicare Advantage Plans

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A battle is brewing between the Centers for Medicare and Medicaid and major insurance companies as Medicare Advantage plans could receive reduced payments next year.  Such a move could cut into profit margins unless insurers cut back on benefits to Medicare Advantage plan holders.  The proposal would change the way Medicare pays insurers.  A “risk adjustment†would give insurers more money for those who are sicker as they will generate higher expenses.  However, the new proposal would either eliminate or reduce payments for some conditions such as atherosclerosis (plaque build up) and a specific type of malnutrition.  The government says this will result in more money for insurance companies but Medicare Advantage plans think differently

Medicare Advantage Plans Taking Advantage Of Some Seniors

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Medicare Advantage Plan members have more than doubled since 2007 according to a study done by the Kaiser Family Foundation.  However, they are not always the great deal as they seem on the surface.  The Wall Street Journal recently profiled Bob Miller who had surgery on one eye but just a few weeks later when he was scheduled to have surgery on the other eye, he was informed the night before that the surgery was canceled because his Medicare Advantage plan refused to cover it.  Unfortunately, you will not be able to figure out if some plans are covering your planned medical care until you fill out the medical preauthorization form and send it in.  Miller eventually got the cataract surgery but had to wait several weeks.  “Prior authorization policy when levelled in such a heavy handed and irrational way is an undeniable power grab by insurers to really put profits over patients,†said Alice Epitropoulos, the ophthalmologist who performed the surgery on Miller.

Medicare Open Enrollment From October 15 To December 7 : Check Your Options!

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Medicare Open Enrollment arrives, with their Annual Election Period (AEP) running from October 15 to December 7.  Those who are in a standalone Part D drug plan should check and make sure that they have the best coverage possible for the prescription medication that they are on.  Coverage and plans change every year so getting the right plan could save you hundreds or even thousands of dollars per year.  Similarly, if you are looking at a Medicare Advantage Plan should look at your likely health needs, including hospitals, doctors, durable equipment, as well as prescription costs.  Alliance on Aging has a number of free presentations on this topic.  Click here for the dates and locations.

Walmart And United Healthcare Form Joint Venture For Medicare Advantage Enrolles

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Walmart announced that it is rolling out a major partnership with UnitedHealth Group to provide healthcare services and improve the patient experience for Medicare Advantage enrollees in certain markets.  The 10-year partnership was announced Wednesday.  The duo will begin the rollout in Florida and Georgia in 2023, where Walmart Health has a combined 15 locations.  Eventually, they plan to roll out the service across the country.  “No matter who your insurer is, this 10-year collaboration is going to enable us to deliver the care needed, first in Georgia and Florida,†Dr. Cheryl Pegus, EVP of Walmart Health & Wellness, said in an interview.  Medicare Advantage plans have increased in popularity in recent years, with the program adding more than 2 million beneficiaries in 2022, boosting the program to 45% of Medicare enrollees, according to a study by The Chartis Group.

Medicare Advantage Plans Routinely Deny Claims And Deny Services

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Sadly, a recent report from the U.S. Department of Health and Human Services inspector general found that 18% of claims that they examined were denied which actually should have been covered.  The denials were often a result of errors in processing claims.  The review also found that the plans turned down 13% of authorizations for medical services that government-run Medicare would have allowed.  The results of the study covered 15 of the largest Medicare Advantage plans in the nation.  The investigators said the Medicare Advantage plans use the same tactics that private insurance companies use to get out of paying legitimate claims in order to reduce costs.  The report recommends more government oversight of the plans.

https://www.usatoday.com/story/news/health/2022/04/28/medicare-advantage-plans-claims-care-federal-report/9569198002/

Medicare Advantage Plans Add More Perks

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Choosing a Medicare Advantage program that is right for you can be difficult due to the wide range of things that they cover—or don’t.  Plans are expanding benefits in 35 out of 41 categories this year, according to a study done by actuarial consultant Milliman.  Vision coverage still ranks as the most common supplemental benefit, with 97% of Advantage plans offering it in 2022, followed closely by hearing (94%), fitness (94%) and dental care (91%).  However, less common benefits like acupuncture and coverage for bathroom safety devices with the number of plans featuring these increasing by 70% and 32%, respectively (Kiplinger’s Retirement Report May 2022, page 15).

Good News For Those On Social Security, Some Medicare Advantage Plans Lowering Prices – By Derek Baine

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Social Security recipients recently got the good news that come January, their cost of living adjustment (COLA) will rise more than it has in decades.  Now more good news as, according to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for a Medicare Advantage (MA) plan is projected to drop 11% in 2022 to just $21.22.  The CMS also projected that Medicare enrollees who buy Part D drug coverage will see their premium rise from $31.47 this year to $33 next year (Source AARP Bulletin, November 2021 Issue, page 4).

Choose Medicare Advantage Plans Carefully

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Once per year, Medicare recipients have a chance to change their Medicare Advantage policy, and they also have the chance to buy a Medigap insurance policy anytime between October 15 and December 7.  But choose carefully.  Although Medicare Advantage policy benefits are pretty transparent, switching to a Medicap policy does carry significant risks.  In most states, Medigap insurers can turn you down due to preexisting conditions, or charge you more based on your health or age.  Don’t cancel your Medicare Advantage policy in favor or a Medigap policy until you fully understand the financial implications.

Medicare Advantage Plans Gain In Popularity : By Derek Baine

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There are so many things that aren’t covered by Medicare that seniors are increasingly opting in for supplemental coverage, which are marketed under the Medicare Advantage moniker.  Debuting 25 years ago, 42% of Medicare recipients now subscribe to a Medicare Advantage plan, up from just 13% in 2005.  Dental, vision, and even gym memberships and transportation to doctors appointments are included in some Medicare Advantage plans.  Check coverage closely!

Monterey, CA Join The Alliance On Aging For A Zoom Meeting On Medicare Friday at 4:00


Join the Alliance on Aging this Friday for a zoom meeting on understanding the basics of Medicare.  Experts will discuss Part A, Part B, Part C Advantage Plans, Part D, Supplemental Plans, Penalties, Low Income Assistance Programs and more.  The meeting ID is 824 2926 4235 and the passcode is 739283, please see the link below.  If you don’t have access to a computer you can call in at 1-866-900-6833.  For more information, contact Moncerat Politron at 646-5049.

https://us02web.zoom.us/j/82429264235?pwd=UTJFdmJDQVBSQWUxWjNNSHpnQmJIdz09#success