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.

It’s Official: CIGNA and Anthem to Merge

Today it was officially announced that CIGNA and Anthem have struck a deal to become, for now, the largest health insurer in America. The terms of the final deal finally having weathered the storm of a two-month long negotiation, the deal is said to be worth $48 Billion to CIGNA for its acquisition into Anthem.

The independent market is still waiting to hear how this will impact the Medicare Supplement and Medicare Advantage distribution channels. The deal might take two years to get through regulator's approval.

As always, we'll have the specific news when it's available as to how this will impact the individual agent. – Stay tuned!

-CW
See the announcement:

CIGNA Anthem Merger Announcement

 

 

 

 

 

 

 

 

 

 

 

 

 

Medicare Training for Agents at MedicareAgentTraining.com

2016 Medicare Advantage Numbers Coming

CMS is gearing up to release the 2016 funding levels on February 20th, 2015.

Last year, there was a lot of intense lobbying in Congress after the first set of numbers were released, then they were changed due to these lobbying efforts.

What will happen this year? Speculation ranges from .8% increase, by JP Morgan Chase, up to 2% increase by other industry watchers. Medicare Advantage rates are not just driven by the needed numbers. Moreso, the increase or decrease is driven by politics.

We will see soon…

A good article on the topic:
Lobbying Peaks as Rates for Medicare Advantage Expected

 

From the former debate:

 

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

 

Forbes Echoes Westfall’s Observation of Medicare Advantage Cuts, and Why

In a recent story by Forbes online, they state:

“The Obama team has made a warm embrace of managed care options when it comes to Obamacare and Medicaid. But for Medicare, they want to deny low-income seniors these options. All of the administration's old arguments on why they resisted these private Medicare plans have been largely mooted, or never materialized.”

The Forbes.com article goes on to site a study that says at least 13% of Medicare Advantage plans expect to be eliminated by 2015. The agent in the Medicare market must strongly consider having a deeply rooted anchor in the Medicare Supplement market, as we do.

As always, I'll continue to keep you updated on the changes and opportunities in this awesome marketplace, here on MedicareAgentTraining.com.

Source:  More Cuts In Store For Medicare Plans — Here Are The Options That Will Shrink Most For Seniors
http://www.forbes.com/sites/scottgottlieb/2014/01/06/more-cuts-in-store-for-medicare-plans-heres-the-options-that-will-shrink-most-for-seniors/?goback=%2Egde_2479603_member_5826692941543927812#%21

Medicare Advantage Cuts Coming – Westfall’s Prediction Confirmed

On the Friday webinar for members, held January 3, 2014, I laid out the predictions from all of the experts on the decline for Medicare Advantage business in the near future. This is for a variety of reasons, not the least of which was the shenanigans employed by the president just prior to the election, where Medicare Advantage would be propped up to shield seniors from the cuts in the ACA – until just AFTER the election.
See the webinar on this topic here:

PlayButtonMedicareAgentTraining_175x117

Today, an article was written by Bloomberg pointing to the same conclusion.

http://www.businessweek.com/ap/2014-01-03/analysts-expects-slower-medicare-advantage-growth

It is an interesting read, and further proves my prediction was correct. Medicare Supplements are the wave of the future, not Medicare Advantage!

Make sure that you're a member of MedicareAgentTraining.com to get the latest, even before the pundits, on what's happening in our market. If you're not a member, you can join here.

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
https://MedicareAgentTraining.com – for agents only
Seniors should visit: http://SeniorSavingsNetwork.org

More Medicare Advantage Cuts Announced

Today, another news story covers the impact seniors will feel next year from the Obama Administrations cuts to Medicare Advantage.

We strive to let seniors know of the benefits and freedoms affordable by a Medicare Supplement plan.

This is in sharp contrast to the limitations, restrictions, and now, higher prices they will see on Medicare Advantage for 2014. -CW

From:  http://cnsnews.com/news/article/obama-administration-plans-cut-medicare-advantage-reimbursements

In this June 19, 2012 photo, Dr. Bruce Stowell examines patient Robert Busch at his office in Grants Pass, Ore. (AP Photo/Jeff Barnard)

Obama Administration Plans to Cut Medicare Advantage Reimbursements

(CNSNews.com) – The Obama administration is planning new cuts to Medicare, a federal regulatory filing reveals, cuts that could mean higher premiums or seniors losing their coverage altogether.

The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.

In a Feb. 15 regulatory filing, the Centers for Medicare and Medicaid Services (CMS) announced the surprised rate cuts of 2.3 percent – meaning it would pay health care providers 2.3 percent less for providing services to patients.

CMS said it was cutting payments because it foresaw the overall costs of the Medicare Advantage program shrinking by 3.2 percent, despite the fact that health care costs – the driver of all federal health care program costs – are only rising.

Medicare Advantage is like traditional Medicare except that its plans are administered by insurance companies, who are paid a per-enrollee reimbursement fee by the government. If insurance companies can provide care to seniors at less than what the government pays them for it, they make a profit.

Medicare Advantage provides coverage for approximately 28 percent of all Medicare beneficiaries, offering them higher-quality services and additional benefits, such as vision and dental care, than the traditional government program at slightly higher cost.

The Obama administration already plans to cut the Medicare Advantage program by $200 billion as part of Obamacare. However, the proposed reductions it announced in February are new, and will cut the program in addition to the planned $200 billion in Obamacare cuts, most of which are delayed in 2014.

The new cuts are also scheduled to go into effect in 2014, but as a function of the normal rate-setting process for that year, not a political effort to delay financial pain for seniors past an important election, as apparently was the case with the original Medicare cuts that Obama signed.

In its regulatory announcement, the CMS said it was assuming that reimbursement payments in traditional, government-run Medicare will be cut, and cited that as justification for cutting Medicare Advantage.

However, while those cuts to traditional Medicare have been set into law for more than a decade, Congress has never allowed them to happen, instituting what is known as the Doc Fix every year, to keep reimbursement payments the same.

Senator Marco Rubio (R-Fla.) wrote to the CMS urging them to consider political reality and reverse their planned Medicare Advantage cuts.

“This assumption is highly problematic because – even though it almost certainly will turn out to be wrong – it translates into lower funding to support the health benefits of the 14 million Medicare beneficiaries who are currently enrolled in MA [Medicare Advantage] plans,” Rubio wrote on March 8.

In other words, if the Obama administration continues with its proposed new Medicare cuts, some or all of the 14 million seniors who get health care through the MA program could be negatively affected, that is, paying higher premiums or possibly losing coverage.

This is because the proposed cut could make the program unprofitable for insurers, who would be forced to either stop offering MA plans or pass the increased costs on to seniors in the form of higher premiums.

One health insurance provider told its shareholders that the proposed rate cuts could mean the end of Medicare Advantage all together.

“There are going to be some markets that at these rates, if they go the way they’re going, it’s going to be very hard for Medicare Advantage to survive,” Universal American Corp CEO Richard Barasch said in a February 19 conference call with shareholders, the industry publication Health Plan Weekreported.

“I think it’s going to be sort of a market-by-market, company-by-company exercise,” Barasch said.

Source:  http://cnsnews.com/news/article/obama-administration-plans-cut-medicare-advantage-reimbursements