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Medicare Advantage to be Taxed Unless Congress Acts

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medicare advantage HIT tax

24 National & Local Groups Call On Congress To Delay Health Insurance Tax

Seniors & Disabled on Medicare Face $245 Increase in 2018 Premiums

NEWS PROVIDED BY

Better Medicare Alliance

Sep 13, 2017, 17:11 ET

WASHINGTON, Sept. 13, 2017 /PRNewswire/ — Twenty-four national, state, and local organizations representing providers, community partners, and beneficiaries sent a letter to U.S. Congress calling for swift action to delay the Health Insurance Tax (HIT) for one year.

Over 20 percent of the $14.3 billion tax on health insurance falls on Medicare Advantage and Part D plans that could result in rising premiums and/or increased cost sharing paid by seniors and other beneficiaries covered by Medicare Advantage and prescription drug coverage under part D.

Though Congress previously suspended the tax for 2017, it is scheduled to be reinstated for 2018.  If Congress does not act to delay the HIT, premiums for Medicare Advantage beneficiaries could increase by $22 billion nationwide in 2018 – an additional $245 per year for each enrollee.

“During a time where there is already so much uncertainty among seniors and disabled Americans about health care, Congress has a small window of opportunity to avoid harmful premium increases on beneficiaries. Higher premiums could put the high-quality, comprehensive health coverage Medicare Advantage provides financially out for reach for millions of Americans living on fixed incomes,” said Allyson Y. Schwartz, Better Medicare Alliance (BMA) President and CEO.

An August 2017 actuarial analysis from Oliver Wyman indicates that beyond 2018, premium increases for senior and disabled Medicare Advantage beneficiaries could grow to more than $300 in 2023.

“Forty percent of Medicare Advantage enrollees live on less than $20,000 per year. Medicare Advantage is an important source of coverage for low-income and racial/ethnic minority beneficiaries. For those who suffer from chronic conditions, barriers to critical primary care and disease management covered by Medicare Advantage could be devastating,” said Dr. Elena Rios, President of the National Hispanic Medical Association.

“With Medicare Advantage, providers can deliver the type of important preventive care and chronic care management once reserved for wealthy individuals at far lower premiums and out-of-pocket costs. As Medicare Advantage practitioners who treat low-income seniors across six states, we know firsthand that many simply will not be able to afford premium increases,” said Dr. Christopher Chen, CEO of ChenMed, a primary care provider for seniors headquartered in Florida.

In 2016, nearly 400 Democrats and Republicans in Congress voted to delay the impact of the HIT for 2017. As a result, the average Medicare Advantage monthly premium is four percent lower this year compared to 2016 when the tax was in effect. The letter calls on Congress to vote to delay the tax, before premiums for 2018 are finalized by the end of the year.

View full letter signed by the following organizations:

Area Agency on Aging Palm Beach / Treasure Coast, Inc. (Florida)
Association for Behavioral Health and Wellness
Better Medicare Alliance
ChenMed (Florida)
Healthcare Leadership Council
Iora Health (Massachusetts)
Meals on Wheels America
National Association of Dental Plans
National Association of Nutrition and Aging Services Programs (NANASP)
National Hispanic Council on Aging
National Hispanic Medical Association
National Medical Association
National Minority Quality Forum
New Jersey State Nurses Association
Northwell Health (New York)
Nurse Practitioner Association New York State
Philadelphia Corporation for Aging
Pittsburgh Business Group on Health
Prevea Health (Wisconsin)
SilverSneakers by Tivity (Tennessee)
SNP Alliance
Summa Health System (Ohio)
Teachers' Retirement System of Kentucky
US Chamber of Commerce

Better Medicare Alliance is the leading coalition on Medicare Advantage.
Our mission is to build a healthy future by advocating for a strong Medicare Advantage. As a community of experts, we're leading the way on health care through research, advocacy, and grassroots organization to create a path forward for innovative, modern health care on behalf of seniors and people with disabilities.
For more information, please visit www.bettermedicarealliance.org.

SOURCE Better Medicare Alliance

Related Links

http://www.bettermedicarealliance.org

Medicare Advantage for Turning 65

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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

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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

Questions over Medicare Advantage Fraud

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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?

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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

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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

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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

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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

 

The importance of Medicare Agent Training

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Medicare Agent Training

Medicare agent training is very important.

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.

Thank you for visiting Medicare Agent Training.