Will MA plans change next year?

policy doctor

1000 Post Club
Analysis: Private Medicare under fire


WASHINGTON, May 23 (UPI) -- Democrats appeared one step closer this week to cracking down on private insurance companies that offer a growing number of Medicare plans.

Lawmakers are pledging this summer to push legislation that reins in some of the plans, which they say charge the government inflated prices while sometimes using misleading marketing tactics to entice vulnerable seniors into signing up.

Supporters of the plans, including the Bush administration, say the plans provide vital extra benefits to many rural and low-income seniors. They warn that cuts threatened by Democrats could undermine healthcare access for millions of seniors participating in the growing program, known as private fee-for-service plans.

The plans frequently offer coordinated disease care and disease management services not available with traditional Medicare plans offered by the government. Only about 1.5 million seniors currently use private fee-for-service, mainly in rural areas.

But lawmakers have criticized the program because the government pays companies an average of 19 percent more per beneficiary than it pays for traditional Medicare services. In House hearings Tuesday, lawmakers also complained that the plans operate without strict government oversight.

Some witnesses told lawmakers that high payment rates and a lack of oversight had led to a kind of "gold rush" by companies. The plans rush to sign seniors, sometimes resorting to misleading information and other illegal marketing tactics to enroll as many as possible.

Rep. Fortney "Pete" Stark, D-Calif., chairman of the House Ways and Means Health Subcommittee, warned that private fee-for-service plans could face curbs, most likely in Medicare reform legislation planned for some time this summer.

"As we look to improve and protect Medicare, all provider payments must be reviewed and are subject to change. Given what we know about PFFS at this time, they're at the top of my list," he said.

Brock Slabach, a board member of the National Rural Health Association, told lawmakers that seniors enrolling in a plan often don't know that physicians are not required by Medicare to accept the plans.

"When beneficiaries actually need the services is when they discover the gaps," he said.

"Prospective enrollees are being told outright lies," David Lipschutz, staff attorney with California Health Advocates, told the committee.

But Bush administration officials defended the plans, saying they offer care coordination services that chronically ill Medicare beneficiaries often cannot get in other plans.

PFFS plans also allow beneficiaries to keep their additional benefits even if they move throughout the country, said Leslie Norwalk, administrator of the Centers for Medicare & Medicaid Services.

"I think it's important to be cognizant of what those benefits are," she told reporters in a briefing in advance of the House hearings.

One day before the hearings, CMS proposed new federal rules forcing insurers to report to the government on their marketing practices.

Responding to the new scrutiny of PFFS plans, insurers said the higher government subsidies are key to offering additional benefits. "If Congress cuts ... funding, the (PFFS) product is unlikely to remain a stable product in many areas," said Kathryn Schmidt, vice president of Blue Cross Blue Shield of Michigan.

Proposed cuts could come as part of a broader bill cutting Medicare physician payments and increasing consumer protections under the program's Part D prescription-drug benefit, congressional aides said.

Although she also warned against cutting the program, Norwalk suggested PFFS plans and other privately run plans under the "Medicare Advantage" program were likely to face curbs.

"I have no doubt that Medicare Advantage is bound to look different after this year," she said.

Copyright 2007 by United Press International
From strictly a SALES point of view, it is wonderful that MA plans change every year. Since all MA plans are guaranteed issue, we have the opportunity to do our jobs and provide the best MA plan each year for our clients.

This means that our clients have the best available plan each year, and we receive a new commission for our efforts.

In California, agents have the same opportunity with Medicare Supplements. Medicare recipients have can change to a similar plan with an other carrier on first of the month following their birthday. I am not doing my job if I don't review their plan at least annually to see if they have the lowest premium available. (I understand this is also in Missouri but on the policy anniversary.)

All plans have their place. While I prefer the coverage from a supplement, I have written about 100 MA plans this year, almost all of the PFFS.

Lastly, I am 100% in favor of all insurance being provided by the private sector so the more we can transfer from the government (ie. Medicare), the better.


P.S. I'm proud of myself. I finally have a longer-winded post than Frank!
Yep...change is good in our industry. Always a new crop to harvest with "new and improved". And with those low, low renewals, my loyalty has to include me too.
MA plans will still be here, but they will change.

AARP, the loudest voice for seniors, said in April that they will be in the MA market in 2008.

However, in their 2007 Trusties Report about Medicare, they stated that they are against the over-payment of MA plans.

That tells me that there will be more changes, but more players in the market as a whole.
"Will MA plans change next year? "

Yes, and every year thereafter.

The contracts of the plans with CMS are year to year. Even if funding remains relatively level for the next year, you can expect at least some small changes in premiums and/or benefits from year to year. The plan information for the coming AEP will likely be available by early-mid October.
MAs are getting 19%-50% more than basic Medicare

Washington Bureau -- NU Online News Service, May 25, 2007, 2:59 p.m. EDT
Senate Finance Committee Chairman Max Baucus is criticizing what he describes as “advocacy” by the Centers for Medicare and Medicaid Services for private Medicare plans.
A briefing that CMS officials held before a recent House Ways and Means Committee subcommittee hearing on Medicare Advantage fee-for-service plans promoted the point of view that “access to benefits is at stake if Medicare Advantage funding is cut,” Baucus, D-Mont., writes in a letter addressed to U.S. Health and Human Services Secretary Michael Leavitt.
The officials who led the CMS Medicare Advantage private FFS briefing, Acting CMS Administrator Leslie Norwalk and Abby Block, director of the CMS Center for Beneficiary Choices, and the documents the officials presented failed to explain that the plan administrators, not Congress, determine the level of extra benefits that the plans can provide, Baucus writes in the letter.
Only the level of the extra benefits would be affected by the proposed funding cuts, Baucus writes.
“I find it inappropriate that CMS, or any executive branch agency, would lobby in response to anticipated congressional action,” Baucus writes. “State-level MA information was shared with the press, but not offered to members of Congress or their staffs in advance” of the briefing.
“The Finance Committee has yet to consider legislation to reduce MA funding, making the preemptive nature of CMS’ action that much more unseemly,” Baucus writes.
The Medicare Payment Advisory Commission has recommended that Congress lower Medicare Advantage payment rates, and much of the House Ways and Means subcommittee hearing focused on the overpayment made by Medicare to private fee-for-service plans.
The commission estimated, in an analysis questioned by private insurers, that the private FFS plans get 19% more than basic Medicare plans for health coverage services and that some FFS plans are getting 50% more.
Under federal law, plans are required to spend 75% of the extra funds they receive on beneficiaries, either by lowering co-payments and premiums or by enhancing benefits. However, a CMS official acknowledged at the hearing that while CMS believes it can accurately assess how plans are spending the funds, it does not require any documentation of the way the funds are used.
In other health oversight news, Baucus and Sen. John Rockefeller, D-W.Va., chairman of the Senate Finance Committee’s health subcommittee, say they have secured emergency funding for the Children’s Health Insurance Program in a supplemental spending bill.
About 11 states say they are running out of the federal funding they need to provide CHIP coverage.
The program, which provides health coverage for 6.6 million U.S. children, is set to expire Sept. 30.
A supplemental spending bill will provide up to $650 million to fill in CHIP funding gaps while members of Congress negotiate reauthorization of the program, Baucus says.
Last edited:
Well I don't think much much of Sen Baucas or Rockerfeller, but I'm sure that the change of Advantage Plans isn't going to be all that severe. Lets face it, this Democratic controlled Congress is out of control and unable to effect change in any thing. Even the so called "Juggernut" of Illegal Amnesty last week is dead this week. What a pathetic group the Dem's have up in Congress, kind of reminds me of their old saying, "glad my enemies are them!".