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Comment by Jay Lackritz on April 2, 2013 at 8:40pm

U.S. to Raise Medicare Advantage Payment Rate

  In a reversal that followed intense lobbying from the health insurance industry and members of Congress, the U.S. government said it will increase the payment rate for health insurers that offer coverage through the popular Medicare Advantage program.

The Centers for Medicare & Medicaid Services said on Monday it will increase the rate by 3.3% in 2014, reversing a 2.3% cut announced in February.

The turnaround boosted shares of major health insurance companies such as Humana Inc in after-hours trading.

Medicare Advantage provides care for seniors who select to receive their Medicare benefits through private insurance plans. About 14 million Americans are enrolled in the program.

The program has long ensured industry participation by paying more than the cost of the traditional Medicare program for the elderly and disabled. The proposed reduction had followed efforts by the Obama administration to reduce how much money it pays private insurers as an incentive to participate.

In announcing its final rates for 2014 on Monday, CMS said the changes came "after careful consideration of public comments."

"The policies announced today further the agency's goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice," Jonathan Blum, acting principal deputy administrator for the CMS, said in a statement.

Since the initial rate announcement in February the agency, part of the U.S. Department of Health and Human Services (DHHS), has encountered weeks of heavy lobbying by health insurers, whose share prices dropped sharply on the planned rate cut.

Some insurers hinted they would drop their Medicare Advantage business for 2014 if the government did not back down.

Lawmakers on both sides of the aisle took those concerns on board. More than 160 of them joined an effort to reverse the previously announced rate cut, according to America's Health Insurance Plans (AHIP), which launded Monday's decision.

AHIP has released several lawmaker letters expressing worry about the proposed Medicare Advantage payment cuts, including three last week from bipartisan members of the New York House delegation; the entire Massachusetts House delegation, all Democrats; and six other House Democrats.

"We have concerns that if CMS does not make this adjustment, many Medicare Advantage enrollees in Massachusetts, and across the country, will face higher premiums and fewer benefits," said the Massachusetts delegation's letter, which was addressed to Marilyn Tavenner, acting CMS administrator, and dated March 27.

Earlier in March, a large bipartisan group of senators highlighted the threat of plans potentially exiting the Medicare Advantage market altogether.

Meanwhile "The Coalition for Medicare Choice," which is funded by AHIP and other private insurers, launched a full-throated attack on the proposed cuts through television advertising and social media.

Read on: http://www.foxbusiness.com/news/2013/04/01/in-reversal-us-to-raise-...

http://www.nytimes.com/2013/04/03/business/daily-stock-market-activ...

Comment by Jay Lackritz on February 15, 2013 at 1:53pm

The Medicare Competitive Bidding Program is expanding to include diabetes supplies in 2013. I posted a message on this topic in the diabetes group, so if you are interested, you can read it here in the discussion forum:

http://www.transplantfriends.com/group/diabetes

Comment by Jay Lackritz on December 10, 2012 at 8:15pm

A message from Rue to all members of Insurance on Transplant Friends! Hi friends, I am listed for a double lubg transplant at the Cleveland Clinic for the last 2 years. My Cobra is running out in April and I will be eligible for Medicare. I find everything I am reading a bit confusing and was hopeing to find some help from others that have been in this situation. Is it better coverage to do a medicare advantage PPO vs a Medgap thing? Call me confused??? My new e-mail address is cakileh@yahoo.com Any help would be greatly appreciated! Rue

Jay replied:

Hi Rue,
Medicare Advantage Plans are considered "opting out" of Medicare. They are cheap (often free), but restrict who can can see, what tests they pay for, etc. They normally come with a Part D drug policy, and you must use theirs. You cannot switch Part D's unless you switch your MA plan. Everything goes through the private insurance company. You don't even need to show your Medicare card, the MA plan handles it all.
A Medigap policy is considered "Original Medicare". You can see any doctor or go to any facility that accepts Medicare. If Medicare approves a procedure, then you will be able to get it. No insurance company can dictate your coverage. Medigap policies have different available plans. Plan 'F' is the most expensive, and pays for everything. You will not have to pay one red cent out of your pocket for Medical care. The Medicare booklet describes the different plans. No Medigap policy comes with a drug plan, so you need to pick one, but you can pick any one, and can change annually.

So... it mostly depends on what coverage you want. The more you have to pay in annual premium, the less you'll have to pay for your care.
IMO If you can afford it, you would be best off with a Medigap Plan 'F' and a separate drug policy (Part D), until you are a couple of years out, and then you can switch to a cheaper plan.

If you have any questions, just give a yell. If you ask on the friends site, rather than in private, others can share in your questions and answers.

Best, Jay

Comment by Rachel on November 29, 2012 at 9:09pm

Hello everyone

Today I called Medicare to ask if I would be able to come back to medigap if I didn't like manage care and the lady I spoke to would only give me info. on people 65 N over.  She referred me to Texas Health Depart., I did call and they told me they didn't handle medicare/medicaid and referred me to someone local a benefits couselling office.  I called and they took my info and promise to call me before the 7th.   I called my medigap and the lady told me  it will go up again next year, I guess I'll deal with it then.  In the meantime I'm applying for a deferment on a loan I have to be able to pay for the medigap.  This is giving me one big headache........

Comment by Rachel on November 28, 2012 at 7:01pm

Hello

 

currently have plan a supplement and today I tried to switch to another plan a and couldn't do it.  The social worker told me I wouldn't be able to but I told her that the  insurance agent  said I could.  Filled out the paperwork and she called it in and thats when they told no can do.  Because of my age I'm only eligible to enroll in a plan a one time.  I can go from medicare to a manage care.  The social worker says the patients at the hospital where I go, have had no problem with the manage care except for one man.  This man got sick and had to the tx docs but had to be referred by his primary and since he hadn't been seen they woudn't refer him.   I don't want to run into this problem.

Comment by Jay Lackritz on November 25, 2012 at 6:40pm

Rachel,
I looked up the rules in Texas, and yes, it seems that if you are under 65, they only have to sell you a Plan A supplemental policy. After you turn 65, you can switch to a Plan C, F, or N, for better coverage. They say that if you are under 65, and are unhappy with the Plan A Medigap policy, you can join a pool for a different policy that covers more. In 2014, the ACA (Obamacare) takes effect, so there will be cheaper policies that you can sign up for. Also, beginning in 2014, insurance policies cannot contain a 'cap', and you cannot be denied for a policy due to a pre-existing condition.
Here's the Texas web site that covers these issues:
http://www.tdi.texas.gov/pubs/consumer/medsup.html
And here's their under 65, disability info on Plan A's:
http://www.tdi.texas.gov/pubs/consumer/ratesa1.html

Comment by Rachel on November 23, 2012 at 9:39pm

Hello

Spoke to an Insurance agent today, he tells me that I can't get a medicare supplement plan F or N because of my age in TX.  He said these are lots better than the one I have now (plan A).  Once I turn 65 this would be ideal.  For now he suggests manage care ppo./medicare advantage.  I told him I wanted to keep seeing my docs I see now, so he's going to give me some quotes and I'm suppose to give him a list of docs/n meds next week.    He told me the plan a doesn't  have a cap  where as the manage care does which I liked.  We'll see.

Comment by Jay Lackritz on September 19, 2012 at 1:56pm

Mark said:

"Heading for Medicare in May ... big decisions ahead!"

Welcome to the Insurance group Mark. Just ask if you have any questions or need any tips. Of course, everything could change in January depending on the election results, but we'll just have to wait and see if any of the rules change.

Comment by Jay Lackritz on December 3, 2011 at 5:46pm

Hi Kathie,

Sorry for all the abbrev. :)

LOX stands for Liquid Oxygen. And Helios makes two portables for LOX, the H300 (Plus) small unit, and the bigger Marathon. When I was on O2, I had a Marathon and loved it. The smaller Plus doesn't have a continuous flow mode, while the Marathon has both pulsed and continuous, up to 6 Liters.

One of the best reference sites on the net is:

http://www.portableoxygen.org/

They have comparisons of POC units, discussions on motoring or flying with oxygen, and much, much more.

Comment by kathie on December 3, 2011 at 2:22pm

Thanks for comments on insurance.  Jay, what is LOX?  My MA is a PPO, so hopefully that will help when buying or renting the Helios unit, if that is even covered by the MA plan.  I appreciate any information about portable oxygen, so I at least will know what to ask the insurance company.  kathie

 

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