1970 -1996: Private HMO and PPO plans fail to compete/catch on. 1997 - named ”Medicare Choice”; Clinton 3% subsidy. 1997 -1999: subsidies for rural counties; share to 21% then falls to 18%. 2000 - 2003: Benefits Improvement & Protection Act (BIPA) reset floor payments - raised in urban & rural counties but share falls, to 13%. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 2003 : MMA adds 14% subsidies; renamed MA; share to 24% by 2010 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 2016 - 2017: ACA ordered 14%; but Star Awards used to keep 6% in 2017 2017- 2018: MA Rebates, risk adjustments and quality bonuses (star awards) boost marketing hype and market share jumps to 33% in 2018. MA ENROLLEES GROW: 11.1 MILLION IN 2010, 22.6 MILLION IN 2019 (est.) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 EVOLUTION OF PRIVATIZATION & MEDICARE ADVANTAGE PLANS
Transcript
1970 -1996: Private HMO and PPO plans fail to compete/catch on.
1997 - named ”Medicare Choice”; Clinton 3% subsidy.
1997 -1999: subsidies for rural counties; share to 21% then falls to18%.
floor payments - raised in urban & rural counties but share falls, to 13%.-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2003: MMA adds 14% subsidies; renamed MA; share to 24% by 2010---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2016 - 2017: ACA ordered 14%; but Star Awards used to keep 6% in 2017
2017- 2018: MA Rebates, risk adjustments and quality bonuses (star awards) boost marketing hype and market share jumps to 33% in 2018.
MA ENROLLEES GROW: 11.1 MILLION IN 2010, 22.6 MILLION IN 2019 (est.)-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2019 - CMS increased MA plan Subsidies by 3.40% - $ 9.1 billion
NEW: Trips to fitness centers, doctors, pharmacies, over-the counter meds; eyedrops; vitamins; compression stockings; house calls by doctors & other help providers; home assistance – dressing, eating, chores and light housekeeping; shower grab bars; home delivered meals, wheelchair ramps & A/C units for asthma sufferers.
2020 - CMS plan payment increase of 2.53% - $7.4 billion more
NEW: Shift from prevention & cure to service needs by patients –help with chronic illnesses. Plans may pay for home air filters and carpet shampooing for those with asthma; for heart healthy meals for those with heart disease; and other services determined by patient needs, not just what is on an allowable list.
NEW BENEFITS ARE AVAILABLE IN MA PLANS ONLY! 3
EVOLUTION OF PRIVATIZATION &
MEDICARE ADVANTAGE PLANS
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E V O L U T I O N O F P R I V A T I Z A T I O N &
M E D I C A R E A D V A N T A G E P L A N S
MELTING DOWN MEDICARE LIKE THIS WILL PROVIDE MORE
BENEFITS.
Thank you, Congress and to HHS / CMS for
these 2019 & 2020 New Traditional A & B
Benefits .
HE’S TALKING TO ME! Healthy 65 Year Old Guys
Like You Should Buy A Medicare Advantage Plan.
2019 – 2020 MA Plan Federal Subsidy menus,
Rebates, Bonuses & Campaign Contribution
Checks.
Other New Actions and Plans Announced in April of 2019
1) A healthcare insurer (UHC) has announce a private plan that willcombine Medicare and Medicaid.
2) MA insurers are working with the housing industry to includehome - based care delivery in senior housing.
3) in April of 2019, HHS Secretary Alex Azar announced experimentswith new plans to introduce changes in the primary care paymentmodel that will strike at the heart of the Original Medicare Fee-for-Service model.
Subsidized privatization of Medicare A, B & C must be stopped!
VILLAGERS ARE THE LARGEST MODEL CONCENTRATION OF U.S. SENIORS. NRLN ACCESSTO CONGRESS IS IN PLACE AND READY – LET’S HELP OUR KIDS, GRANDKIDS...FRIENDS.
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EVOLUTION OF PRIVATIZATION &
MEDICARE ADVANTAGE PLANS
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MEDICARE ADVANTAGE PLANSIS PREMIUM SUPPORT A BETTER DEAL FOR OUR COUNTRY?
• The Medicare Payment Advisory Commission(MedPAC) reportedthat “MA plan insurers made a five-percent (5%) margin in2016, twice the average of Medicare plans overall. That’s 25%better than the industry’s overall four-percent (4%) marginreported by Standard and Poor’s.”
• The MedPAC, on March 15, 2019 advised Congress…“We projectthe base benchmarks (that is, excluding quality bonuses) willaverage 103 percent of FFS spending.”
• So why not focus on reducing Original Medicare FFS costs, andstrip out the cost of subsidies? Competitive Benchmark bids andgood quality should be expected; insurers must compete forMedicare business. HHS is wasting taxpayer’s money & now ischeating over- age 65 Americans in FFS out of equal benefits!
EVOLUTION OF PRIVATIZATION & MA PLANSMA Plans are more Costly than traditional Medicare FFS Plans
The NRLN Asks Congress and the Executive Branch to:
• Grandfather the 20 million seniors (34%), who have purchasedMA plans in good faith, protect benefits and subsidies.
• Direct Government Accountability Office (GAO), CBO and HHSInspector General to investigate financials of MA and OriginalMedicare Part A and Part B with and without taxpayer subsidies.
• Make 2019 and 2020 subsidies for home air filters and carpetshampooing, heart healthy meals and other services available tooriginal Medicare A & B, FFS enrollees with chronic illnesses.
• Reduce the $85 billion annual wrong and improper paymentsgenerated by Medicare and Medicaid. Sequester savings anduse them to eliminate the 75-year deficits of Medicare A andthen to help offset Medicare B expenses.
EVOLUTION OF PRIVATIZATION & MA PLANS
PROPOSED RECOMMENDATIONS
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MEDICARE ADVANTAGE PLANSIS PREMIUM SUPPORT A BETTER DEAL FOR OUR COUNTRY?
Sample Questions
Just turned 65, health OK – Should I Buy a MA HMO MA plan at a Lower Cost with Out of Pocket Maximum Coverage; or Buy traditional A&B, and a Medigap Plan? If you have future health concerns & money use door #2!
I’m In a MA - HMO plan, should I switch to original A&B and use my guaranteed Issue to get a Medigap Plan? Could save money with HMO but don’t lose your guaranteed issue! If you have money go for Medigap!
Just Turned 65 or in a MA HMO plan but have Pre-Existing Conditions; What next? If financially possible, get A&B & try for Medigap!! Critical Path.
I’m in original A&B plan & Medigap G, Should I switch to an MA – HMO or PPO Plan to get Out of Pocket Max Protection? Only if you need money and / or are a younger, healthier retiree!
EVOLUTION OF PRIVATIZATION & MA PLANS
OK NRLN, BUT What Should a Villager Do?
Some Medigap vs MA Plan Shopping Information
5 Common MA Shopping Plan pitfalls: 1) underestimating total OOP, 2) not realizing the difficulty of getting back to Medigap,3) Hoping expensive drugs won’t be needed, 4) failing to see network travel limitations, 5) losing coverage due to living in multiple states, in year.
A 66-year- old diabetic & two heart-attacks can’t find low cost Medigap!
Selection good on FL – 43% penetration, 2nd place tie with OR; IL 56%; U.S. Average 34%
MA insurers (% enrollees)–U.N.C. 25%; Humana 17%; BCBS 13%, Aetna 8%; Kaiser 8%,
2018 - MA plan enrollees with extra benefits: Dental 62%; Fitness 69% Eye Exams 77%
2018 U.S. Average MA plan premium $34 (51% had $0; 49% averaged $70)
2018 Medicare “D” premiums included in 88% of MA plans; 50% pay no premiums; 50% pay average of $70. Total enrollee average 34%. HMO average / enrollee $26.
2018 MA enrollees OOP costs for A&B averaged $5,187, all plans; HMO’s $4908.
2019 MA plan In-Network Out of Pocket Max Cap is $6,700 (average all U.S. Counties)
2018 MA bonuses grew: $3 billion in 2015 $6.3 billion ($321/all; $260/Individual plans)
EVOLUTION OF PRIVATIZATION & MA PLANS
OK NRLN, BUT What Should a Villager Do?
Some Medigap vs MA Plan Shopping Information
5 Common MA Shopping Plan pitfalls: 1) underestimating total OOP, 2) not realizing the difficulty of getting back to Medigap,3) Hoping expensive drugs won’t be needed, 4) failing to see network travel limitations, 5) losing coverage due to living in multiple states, in year.
A 66-year- old diabetic & two heart-attacks can’t find low cost Medigap!
Selection good on FL – 43% penetration, 2nd place tie with OR; IL 56%; U.S. Average 34%
MA insurers (% enrollees)–U.N.C. 25%; Humana 17%; BCBS 13%, Aetna 8%; Kaiser 8%,
2018 - MA plan enrollees with extra benefits: Dental 62%; Fitness 69% Eye Exams 77%
2018 U.S. Average MA plan premium $34 (51% had $0; 49% averaged $70)
2018 Medicare “D” premiums included in 88% of MA plans; 50% pay no premiums; 50% pay average of $70. Total enrollee average 34%. HMO average / enrollee $26.
2018 MA enrollees OOP costs for A&B averaged $5,187, all plans; HMO’s $4908.
2019 MA plan In-Network Out of Pocket Max Cap is $6,700 (average all U.S. Counties)
2018 MA bonuses grew: $3 billion in 2015 $6.3 billion ($321/all; $260/Individual plans)
