Medicare Advantage for Turning 65

Approximately 30% of Americans turning 65 are opting for a Medicare “Advantage” plan. In my experience, this most often happens for the following two reasons:

  1. They have been relatively healthy up to 65 years old
  2. They believe this great health will continue into their senior years
  3. Medicare Advantage plans at $0 per month can be quite attractive
  4. They miss, or minimize the often $6,700 Maximum Out-of-Pocket PER YEAR

Sadly, there are many situations that we have seen where a Turning 65-senior has chosen one of these “free” Medicare Advantage plans only to have to experience the limitations and large hospital admission co-payments by having a serious illness that takes them into full usage of their chosen plan.

When they were first turning 65, they thought their great health would continue far into their senior years, only to discover that this is the time frame where most all medical claims are experienced in life. Sadly, when they signed up for a Medicare Advantage plan, particularly an HMO plan, they find that the restrictions now imposed on them, the trade off for little or no monthly premium, now can significantly and adversely not only affect their availability of specialty care (replaced with tight networks) but also expose them to more money spent for medical care than their non-“Advantage” plan senior counterparts.

On the contrary, the biggest proponents of Medigap (Medicare Supplement) plans are those who have had to use them with a serious illness. For example, those with a special kind of cancer who can now choose the best cancer treatment centers in America without consequence because their Medicare Supplement plan allows them to go anywhere. Those who would have otherwise been exposed to a $6,700 out-of-pocket cost with their Medicare Advantage plan for a series of hospital admissions who though, because on a SUPPLEMENT plan instead, pay $0 for their admissions and, more importantly, get to CHOOSE their hospital instead of only being able to go to the one that was the lowest bidder that joined the “Advantage” plan’s restrictive network.

In an illuminating article by the non-profit Kaiser Family Foundation, the choice of a Medicare Advantage plan when a senior is turning 65 can prove disastrous for future healthcare choices for the rest of a senior’s life. See the article here:

http://kff.org/medicare/perspective/traditional-medicare-disadvantaged/

It is very important that now-Medicare-eligible seniors have the full information on the good, the bad, and the possible devastating effects of picking their Medicare plan.

Chris Westfall is an independent Medicare agent and has been a licensed insurance agent for over 20 years.

 

 

 

New Requirement for MAPD Sales

Do you sell Medicare Advantage plans or Part D plans?

If so, in addition to the AHIP test, there is now another, separate test administered only through CMS and it is required.

This test is on Waste, Fraud, and Abuse, as there always had been in the AHIP test already, but now it’s required separately.

Courtesy of United Healthcare, this is a link to the instructions as to how to find and take this simple test:

Click here for the document

 

Medicare Supplement Training

CIGNA Healthspring Medicare Advantage Suspended by CMS

From:
http://www.bloomberg.com/news/articles/2016-01-22/cigna-banned-from-selling-medicare-plans-by-u-s-stock-falls

  • U.S. says Cigna has `longstanding history of non-compliance’
  • Anthem, which agreed to buy Cigna, is committed to deal

Cigna Corp. was banned from marketing its Medicare products to new customers, after the U.S. found deficiencies in how the health insurer ran its plans, citing widespread violations that the government said threatened patients’ health.

“Cigna has experienced widespread and systemic failures impacting Cigna enrollees’ ability to access medical services and prescription medications,” the U.S. said in a Jan. 21 letter to the insurer outlining the sanctions. “Cigna has had a longstanding history of non-compliance” with requirements from the Centers for Medicare and Medicaid Services, or CMS.

Cigna and other insurers offer a privately run alternative to traditional Medicare, which includes insurance coverage for hospital and doctor care, known as Medicare Advantage, as well as prescription drug coverage, or Part D. CMS found problems involving Cigna’s appeals and grievances process, as well as with its drug coverage, the insurer said Friday in a regulatory filing.

 Because of those deficiencies, Cigna won’t be allowed to market or sell Medicare Advantage policies or Part D drug plans to new clients. The government said it “determined that Cigna’s conduct poses a serious threat to the health and safety of Medicare beneficiaries.” Cigna clients who are affected by the issues cited by CMS can drop their Cigna coverage and buy policies from other insurers.

Shares of Cigna, which is being bought by Anthem Inc. for about $48 billion, rose 0.1 percent to $140.33 at 10:09 a.m. in New York. Anthem remains committed to the deal, spokeswoman Jill Becher said in an e-mail.

Private Medicare Alternative

“Cigna is working to resolve these matters as quickly as possible and is cooperating fully with CMS on its review,” the health insurer said in the filing, adding that the sanctions don’t affect benefits offered to current enrollees.

For now, the ban mainly affects Cigna’s marketing to people who age into Medicare, the U.S. health program for people 65 and older. Medicare beneficiaries are allowed to shop for new plans every year during a period known as open enrollment that runs from Oct. 15 to Dec. 7.

Cigna, which mainly offers coverage via employers, expanded in Medicare with the acquisition of HealthSpring Inc. in 2012. The company has about 543,500 Medicare Advantage clients and about 1.1 million people in its prescription drug plans, according to data compiled by Bloomberg Intelligence.

Questions over Medicare Advantage Fraud

A report from PublicIntegrity.org details new, and not-so-new investigations into Medicare Advantage potential fraud and abuse around the country. In multiple states, and across providers, Congress is trying to get a handle on the overpayments that are happening with this managed care approach to replacing original Medicare.

See the story here:
Why Medicare Advantage costs taxpayers billions more than it should
Regulators have kept problems secret, and there’s no fix in sight

Whistleblower suit says health plan cheated government out of more than $1 billion

 

Is it legal to call folks about their Medicare plan?

Is it legal to cold call for Medicare plans?

Excerpt from SeniorAgentPodcast on iTunes:

Can I legally call someone and talk about Medicare Supplement plans?

This is a question that was asked by a new agent this week.

The agent said she had heard that you can lose your license, pay a fine, etc. for cold calling someone about Medicare plans.

What the agent is referring to is the marketing of Medicare Advantage Plans.
You can find the marketing rules from CMS about Medicare Advantage plans here.

However, in most all states, it is perfectly legal to telemarketing / cold call, door knock, and approach seniors about Medicare Supplement plans. Only one state, that I know of, has restrictions on the marketing of Medicare Supplement plans.

That state is Ohio. Their law prohibits the following for both Medicare Advantage AND Medicare Supplement marketing.

(2) Any of the following unsolicited contacts with a medicare-eligible person:
(a) Door-to-door solicitation including leaving information such as a leaflet, flyer, or door hanger at a residence, or leaving information such as a leaflet or flyer on someone’s car;
(b) Approaching individual prospective applicants in common areas (e.g., parking lots, hallways, lobbies, sidewalks, etc.);
(c) Telephonic solicitation including leaving electronic voicemail messages;
(d) These prohibitions on marketing through unsolicited contacts do not extend to mail and other media (e.g., advertisements, direct mail), or unsolicited contacts with prospective applicants with whom the entity or insurance agent has a business relationship.
Near the end of this podcast, I have several suggestions for various new ways to market Medicare Supplement plans through centers of influence.

Those referenced interviews are found at MedicareAgentTraining.com

 Hear the audio of the podcast answer here.

New Round of Medicare Advantage Cuts Announced

Glad we are focused on Medicare Supplements, which remain untouched by this news. - CW

Insurers face about 3.6% Medicare Advantage rate cuts

By Alex Wayne and Caroline Chen BLOOMBERG NEWS

 Health insurers participating in the Medicare Advantage program for elderly Americans, including Humana Inc. and UnitedHealth Group Inc., face a payment cut of about 3.55 percent next year, the U.S. government said.

 

The payment reductions proposed Friday are subject to negotiations with the industry and aren’t expected to become final until April 1. Insurers had expected cuts of as much as 6.5 percent and had mounted a lobbying campaign to reduce the amount even before Friday’s filing, including a Feb. 14 letter to the Obama administration from 40 senators urging the government to freeze rates for the program.About 15.9 million people, or about 30 percent of Medicare beneficiaries, are enrolled in Advantage plans this year, according to February data from the government.Next year may mark a turning point: Medicare’s actuaries estimate that enrollment will decline for the first time since 2004 because payment cuts will cause plans to drop out or reduce benefits.

CEOs’ trepidation

“There’s a lot of trepidation awaiting this letter and not a few Wall Street analysts and CEOs who are like a long-tailed cat in a room full of rocking chairs these days,” John Gorman, executive chairman of Gorman Health Group, a consulting firm in Washington, said before the cuts were announced. “There’s all kinds of things around that could hurt.”

Consumers who choose Advantage plans are opting for managed care, with benefits including lower out-of-pocket costs, over the traditional government-run Medicare program for the elderly and disabled. Government payments have been under pressure since 2010, when the U.S. health expansion was financed in part by reducing spending on Advantage plans by an estimated $206 billion over a decade.

At the time, U.S. spending for Advantage beneficiaries was estimated to be as much as 13 percent higher than for people enrolled in traditional Medicare, leading to criticism the Advantage plans were overpaid.

Even after the cuts, the Medicare Payment Advisory Commission, which studies the program for Congress and recommends cost savings, estimates that Advantage plans were paid about 4 percent more in 2013, per beneficiary, than the cost of the traditional program.

‘Seniors are watching’

Last year, the administration raised 2014 base payments for Advantage insurers by 3.3 percent, after initially proposing a 2.2 percent reduction.

Still, insurers say that other government decisions — including a new tax on the industry under the Patient Protection and Affordable Care Act and budget sequestration ordered by Congress — reduced their Advantage payments about 6.7 percent in total this year.

Before Friday’s announcement, insurers predicted a proposed cut of as much as 6.5 percent. Their lobbying campaign has included posters plastered around Washington that picture an elderly man with a pair of binoculars, with the warning “Seniors Are Watching.”

Senators’ letter

The 40 U.S. senators who wrote to Medicare administrator Marilyn Tavenner to ask for payments to be frozen were led by Charles Schumer, D-N.Y., and Michael Crapo, R-Idaho.

The program “has been a great success and should remain a competitive choice for our constituents,” the senators said. “We urge you to maintain payment levels that will allow MA beneficiaries to be protected from disruptive changes in 2015.”

While Medicare actuaries estimate enrollment in Advantage plans will dip next year, the Congressional Budget Office predicted that participation may rise as much as 50 percent in the next decade to 21 million by fiscal 2023.

Read more New Round of Medicare Advantage Cuts Announced

Medicare Advantage Plan Reductions Hurting Seniors for 2014

In this briefing, Chris Westfall goes through the Medicare Advantage changes that are now being followed in the media. Seniors considering a Medicare Advantage plan for 2014 should watch this video and see the writing on the wall.

Update since video:
20% of RI docs leave the MA plan:
http://www.providencejournal.com/breaking-news/content/20131022-ri-medical-society-united-is-cutting-20-percent-of-doctors-from-its-medicare-plans.ece

See the video briefing:

 

References:

http://avalerehealth.net/news/avalere-analysis-reveals-first-drop-in-medicare-advantage-offerings-since-2

http://www.kaiserhealthnews.org/Stories/2013/October/15/medicare-open-enrollment-begins.aspx

http://www.providencejournal.com/breaking-news/content/20131021-unitedhealthcare-dropping-r.i.-doctors-from-medicare-advantage-network-poll.ece
http://MedicareAgentTraining.com – for agents only
Seniors should visit: http://SeniorSavingsNetwork.org