Seniors urged to
review their health and drug plan coverage for any changes their plans
may be making for 2010 before the annual enrollment begins November 15 -
See links below story to key Medicare info on
enrollment
Sept. 22, 2010 –
The Medicare plan that was a key focus of health care reform – Medicare
Advantage – will see an average price drop of one percent in 2011,
according to an announcement yesterday by the Centers for Medicare &
Medicaid Services (CMS). And, the agency added, participation in these plans is projected
to increase by five percent.
The actual cost
of these private plans funded by Medicare will drop 45 cents to $35.69
next year. Last year the plans increased rates to seniors and others by
15 percent.
These plans that
offer a wide range of health care services, including prescription drug
insurance, were heavily subsidized when first introduced during the Bush
administration. A major cost savings for the government in the new
Affordable Care Act is a reduction of this subsidy. (See "About
Medicare Advantage" below this news story.)
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Yesterday’s news
release by CMS said, “The majority of Medicare beneficiaries, on
average, enrolled in Medicare health and prescription drug plans this
year should find little or no change in their benefits in 2011, in
addition to seeing more drug plans offering coverage in the prescription
drug coverage gap or ‘donut hole.’
“Medicare
Advantage plans project that enrollment will increase by 5 percent in
2011. And, consistent with the Affordable Care Act, beneficiaries, in
most Medicare Advantage plans and Original Medicare, will gain access to
preventive benefits with no out of pocket costs.”
More Media Reports
Sep 22, 2010
Administration officials
announced Tuesday that the premiums individuals pay
monthly for Medicare Advantage plans will drop 45 cents
to $35.69 next year, The
Associated Press reports. That's about a 1 percent
savings for the private, Medicare-funded health plans,
but Health and Human Services Secretary Kathleen
Sebelius contrasted it to the 15 percent increases in
2010. "The fate of the plans has been a source of
concern because the new health care law cuts payments to
the private insurance companies that operate them.
However, payment rates are frozen for 2011 and
significant reductions are still a couple of years
away." Officials attributed this year's savings to
"stronger oversight" (Alonso-Zaldivar, 9/21).
"By contrast, commercial insurance premiums for many
people under 65 and many small businesses are increasing
10 percent to 25 percent or more," according to
The New York Times. "Insurers say that a significant
share of the increases is attributable to requirements
of the new law, a contention that infuriates Obama
administration officials and Democrats in
Congress." Policy analysts and lawmakers were taken by
surprise by the news that Advantage premiums would drop
instead of increase. Federal officials, though, said
they used new powers from the health law to negotiate
and reject plan prices granted by the health law to
prevent increases (Pear, 9/21).
The Wall Street Journal: The officials "said Tuesday
they denied rate increases and benefit cuts in 298
cases. As a result, they said, Medicare Advantage
premiums will be 1% lower on average in 2011." They had
received 2,100 bids in total. But, one financial analyst
points out that the premiums "don't tell the whole
story." Copays and deductibles are rising for many
members and some benefits, such as gym memberships, are
being cut. In all, changes next year are expected to
cost seniors an extra $13 a month even as premiums drop
(Adamy and Johnson, 9/22).
NPR's Shots Blog: The plans, however, mostly
"managed to maintain or reduce monthly premiums while
keeping virtually all their benefits intact, including
extras traditional Medicare doesn't offer. How's that
possible? Well, a bunch of big brand-name drugs popular
with seniors are set to go generic in 2011. So the
insurers will be able to save a lot of money by moving
people to the cheaper knockoffs of those medicines,
including cholesterol-fighter Lipitor, blood-thinner
Plavix and blood pressure medicine Cozaar, according to
an analysis by Avalere Health" (Hensley, 9/21).
USA Today: "Virtually none of the 11 million seniors
who choose private health insurance plans under Medicare
will lose access to those plans next year, federal
officials announced Tuesday, despite fears that strict
payment rates under the new health care law would cause
some insurers to drop out. ... 'Despite lots of
predictions of gloom and doom, the Medicare Advantage
program … is stronger than ever before,' Sebelius said.
The government also announced that Medicare prescription
drug premiums will remain relatively stable in 2011, and
more insurance plans will eliminate a coverage gap
included in a 2003 law to make the program affordable"
(Wolf, 9/21).
The Hill: Administration officials said enrollment
in "the controversial Medicare Advantage (MA) program"
will increase in the year ahead. "White House health
officials said the numbers indicate that — despite
threats from conservatives and the insurance industry
that the new healthcare reform law will cripple MA plans
at the expense of seniors — both patients and taxpayers
will benefit from the reforms" (Lillis, 9/21).
Modern Healthcare: "Some MA plans, however, will be
exiting the market 'due primarily to 2008 legislation
that tightened the quality standards for private
fee-for-service plans,' CMS Administrator Don Berwick
said during the conference call. As a result, about
2,300 Medicare Advantage beneficiaries will be left
without a choice of MA plan. 'The insurance industry has
been signaling to pull back from this market for some
time. We will extend every resource to assist these
affected beneficiaries transition to new coverage as
seamlessly as possible,' Berwick said" (Lubell, 9/21).
This is part
of Kaiser Health News' Daily Report - a summary of health
policy coverage from more than 300 news organizations. The
full summary of the day's news can be found
here and you can sign up for e-mail subscriptions to the
Daily Report
here. In addition, our staff of reporters and
correspondents file original stories each day, which you can
find on our home
page.
CMS Administrator
Donald Berwick, M.D., added, "Despite the claims of some, Medicare
Advantage remains strong and a robust option for millions of seniors who
choose to enroll or stay in a participating plan today and in the
future.
“The Affordable
Care Act gave us new authority to negotiate with health plans in a
competitive marketplace. As a result, our beneficiaries will save money
and maintain their benefits."
“Even with the
lower costs, all beneficiaries should take time this Fall to compare
their current health and drug plan coverage with what’s available and
best meets their needs for next year,” said Jonathan Blum, deputy
administrator and director of CMS’ Center for Medicare.
“Medicare will
continue to provide a wide-range of consumer tools to help beneficiaries
make the best possible choice of coverage.”
Virtually the
same percentage of Medicare beneficiaries who have access to a Medicare
Advantage plan today will have access to a Medicare Advantage plan in
2011: 99.7 percent. All Medicare beneficiaries will continue to have
many prescription drug plans from which to choose.
Some seniors,
other beneficiaries, need new plans
One cautionary
note for senior citizens and other beneficiaries from CMS said, “As
expected and, similar to the past five years, about five percent of
non-employer beneficiaries enrolled in Medicare Advantage and
stand-alone Prescription Drug Plans will need to choose a new health
plan or Original Medicare in 2010 because their current plan is not
renewing its contract with Medicare in 2011.”
Most of these
‘non-renewals’ occur because private fee-for-service (PFFS) plans made
business decisions to leave Medicare in certain areas of the country,
largely due to a 2008 law that ensures protections for beneficiaries
enrolled in PFFS plans in certain areas of the country.
All but 2,300
enrollees in Medicare Advantage plans that no longer participate in
Medicare will have a choice of enrolling in a different plan. In 2010,
86 percent of beneficiaries whose plan no longer participated in
Medicare joined a new Medicare Advantage plan.
CMS says it will
continue to work with beneficiary advocates and State Health Insurance
Assistance Programs (SHIPs) and send letters to beneficiaries to make
sure they take the necessary steps to keep coverage that best meets
their needs next year.
Beneficiaries
enrolled in plans that are not available next year will receive notice
of the non-renewal from their plan in the next few weeks.
Beneficiaries who
do not enroll in another health plan will receive medical coverage under
Original Medicare, but must enroll in a Part D plan to keep their drug
coverage. Beneficiaries eligible for the Part D low-income subsidy will
be enrolled in a zero-premium drug plan if they do not select a plan.
CMS recently announced that the average prescription drug plan premiums
for 2011 will remain similar to 2010, increasing by only $1 to $30 per
month.
Through the new
tools provided to Medicare under the Affordable Care Act, and working
closely with Medicare Advantage Organizations and Prescription Drug
Plans, CMS took steps to:
● Protect
beneficiaries from excessive increases in premiums and cost sharing
through aggressive bid reviews;
● Consolidate
low enrollment and duplicative plans so beneficiaries have meaningful
differences between plans offered by the same organization;
● Set limits
on out-of-pocket expenses;
● Cover
preventive services with no cost sharing; and
● Limit plan
cost sharing for skilled nursing care, chemotherapy and renal dialysis
to the amounts paid by beneficiaries in Original Medicare.
CMS points out
new free wellness opportunities
The Affordable
Care Act also provides some new benefits to Medicare beneficiaries in
2011 like free wellness visits, some new free health screenings, and a
50 percent discount on brand-name drugs for seniors who full into the
coverage gap. Beneficiaries should look for information about these
benefits in their open enrollment materials.
In addition, due
to CMS negotiations with plans with excessive increases in premiums and
cost-sharing, plans improved their benefits by $13 per member per month
(5 percent) on average. The average annual reduction of about $155 per
member per year for the 966,000 beneficiaries enrolled in these plans
resulted in an estimated total savings for beneficiaries of $150 million
for 2011, according to the CMS news release.
Start
reviewing your options – Open Enrollment starts Nov. 15
CMS is
encouraging beneficiaries enrolled in Medicare Advantage and Medicare
Prescription Drug plans to review their current health and drug plan
coverage for any changes their plans may be making for 2010 before the
annual enrollment period begins November 15.
In addition to
the 5-Star ratings on the Medicare Plan Finder at www.Medicare.gov,
users will find an icon that shows those plans that had a low overall
quality rating the past three years.
Beneficiaries
should receive their 2011 Medicare & You handbook and find updated
information at www.Medicare.gov and 1-800-Medicare in mid-October.
Users of the Medicare Plan Finder, available at
www.Medicare.gov, will be able to compare plans’ quality summary
rating from the previous year, identify which drugs may or may not be on
a plan’s formulary or be restricted, and compare the cost ranges for
plans available in their community.
Medicare Advantage Plans, sometimes called "Part C"
or "MA Plans," are health plans offered by private companies approved by
Medicare. If you join a Medicare Advantage Plan, the plan provides all
your Part A (Hospital Insurance) and Part B (Medical Insurance)
coverage.
Medicare Advantage plans always cover emergency and
urgent care. Medicare Advantage Plans must cover all the services that
Original Medicare covers, except hospice care. (Original Medicare covers
hospice care even if you’re in a Medicare Advantage Plan.)
Medicare Advantage Plans may offer extra coverage,
such as vision, hearing, dental, and/or health and wellness programs.
Most plans also include Medicare prescription drug coverage.
Medicare Advantage Plans must follow rules set by
Medicare. However, each plan can charge different out-of-pocket costs
and have different rules for how you get services (like whether you need
a referral to see a specialist or if you have to go to only doctors,
facilities, or suppliers that belong to the plan).
This updated fact sheet by the Kaiser Family
Foundation provides an overview of the Medicare Advantage program,
describes program changes made by the new drug law in plan
participation and beneficiary enrollment, presents data on benefits
and premiums, and explains changes in Medicare payments to
participating plans.
>> More about Health
Care Reform on
SeniorJournal.com
(Health Reform Section)
Sept. 22, 2010 –
The Medicare plan that was a key focus of health care reform – Medicare
Advantage – will see an average price drop of one percent in 2011,
according to an announcement yesterday by the Centers for Medicare &
Medicaid Services (CMS). And, the agency added, participation in these plans is projected
to increase by five percent.
Can by costly for senior citizens finding Medicare
won’t pay follow-up for observational hospital stays
