Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government.
In its second round of online provider directory reviews, the Centers for Medicare & Medicaid Servicesfoundthat 52% of the provider directory locations listed had at least one inaccuracy.
Those errors included providers who weren’t at the location listed, providers who didn’t accept the plan at that location, providers who weren’t accepting new patients despite the directory saying that they were, and incorrect or disconnected phone numbers.
When CMS conducted its first review of MAOs’ provider directories, it found that 45% of locations listed were inaccurate. While the report does say that the first and second reviews aren’t directly comparable “due to minor updates to the review methodology,” at the very least, the latest review’s results indicate the problem isn’t getting any better.
CMS also noted that its findings were not skewed by a few organizations but instead were widespread in the sample reviewed, which was about one-third of all MAOs. “Very few organizations performed well in our review,” the agency said.
At a minimum, provider directory errors can make members frustrated with an MAO, the report noted. But they can also cast doubt on the adequacy and validity of the MAO’s network as a whole, and even more seriously, prevent members from accessing services that are critical to their health and well-being.
Based on the results of its reviews, CMS has sent 23 notices of noncompliance, 19 warning letters and 12 warning letters “with a request for a business plan” to Medicare Advantage insurers.
However, the agency emphasized that MAOs themselves “are in the best position to ensure the accuracy of their plan provider directories.” It also said it was encouraged by pilot programs aimed at developing a centralized repository for provider data that would be accessible to multiple stakeholders.
In the near term, CMS added, MAOs should perform their own audits of their directory data and develop better internal processes for members to report errors.
See the original article here:
https://www.fiercehealthcare.com/cms-chip/medicare-advantage-provider-directory-errors-network-adequacy
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:
They have been relatively healthy up to 65 years old
They believe this great health will continue into their senior years
Medicare Advantage plans at $0 per month can be quite attractive
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:
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.
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.
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.
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.
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.
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
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.
Once the product knowledge is digested, the overall important factor that stands between potential failure or success is training in successful marketing. As insurance agents, it is our mission to help others and we are fairly compensated to the extent that we are able to help more people.
Helping seniors with their Medicare plans is, indeed, rewarding.
The satisfaction of being able to help someone to resolve their confusion and find the best value possible for their chosen plan makes you sleep very well at night.
Our agency has experience in selling Medicare Supplement plans 100% by telephone. This way, our senior clients are not feeling intruded upon by having to meet with an agent in their home or in the agent's office. The convenience by which we are able to transact their Medicare decision is not only comfortable for them but very convenient. We do this through a systematic way of first, building trust, and then showing them their options.
Education then turns to a common sense call to action only when it is in their best interest to take such action.
By consistently reaching out to seniors that we can help, and by consistently providing solutions to those orphaned clients of other agents gone by, we will continue to build a growing, residual income by putting the needs of others before our own.
