Coventry Confirms Changes to AEP and OEP.

[GreenSky]

Year round enrollment worked just fine until Part D.

What about the situation where a medical group drops an MA plan in June? Their patients don't have the opportunity to switch to another plan and keep their doctor. How is that crap protecting the public?

I can ALMOST deal with AEP, but why not have at least one SEP for everyone during the year? People who qualify for a LIS have no enrollment periods - why are they special? Because they're low income?

Rick

 

[jdeasy]

Thank God someone actually understand the way insurance works.

I understand how it works, too. I also understand that what you guys are talking about is just typical scare tactics that the companies use/used to get their precious lock-in.

People don't pick up med sups to have a surgery and then drop it. The fact is that the MA companies sold a bill of good to congress that they can't deliver. They know the gig is up and they are using every tactic in the world to hang onto every dollar they can in the interim.

Lock in protects one entity, the insurance company. It is not good for anyone else.

What if they put those rules in effect for FE? How great would that be? "Yes, Mr. Client, I sold you a substandard FE policy. You can do better, but, not until Nov. You will have to keep it until then and you cannot stop paying for it because it would cause a hardship on the company if you actually helped yourself."

 

[retread]

There has been a lot of speculation lately on the up and coming AEP and OEP. Coventry has put out official notice today that there will be no change in this year's AEP and that the OEP as we know it is now gone. They also indicate that the AEP for 2011 writing year (01-01-2012 effectives) will take place starting October 15th and end on December 7th.

All this was speculated by most of us of course. Coventry is the first to actually put the newest dates in print. You can see the release in its entirety by clicking here. As always, we're happy to help with any questions you may have.

I'm sure you know this, but Coventry does not set the AEP and OEP rules, CMS does. What this Broker News Flash from Coventry does, is report some "unofficial" talk between CMS and the MAOs. They are probably going to do this, but it is not "official" yet, because it has not been set forth in writing.
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Yes the ability to drop at any time COULD be good BUT... If someone knew they needed a surgery they could time it in JAnuary. Have the surgery. Go through recovery and then drop the payment for the health plan. Too much of that would cause rates to increase and benefits to decrease for the honest people who always keep a plan. That would penalize the wrong people.

This scenario is more likely for Med Supps, not MAs. Most MA plans are $0 premium with hefty hospital co-pays. Deferring enrollment until just before surgery would not help at all. Med Supps, on the other hand, have NO co-pays, so it is quite likely that someone could try to game the system as you describe. That's why most health questions in the new modernized Med Supp plans now ask if the client has been advised of needed medical attention that has not been accomplished. If they falsify that statement, the insurer can then deny the claim.

Of course, this would only apply to fully UW enrollees... Open enrollment and GI would not, but then again, this would not work for those waiting for surgery anyway.

 

[Josh]

Year round enrollment worked just fine until Part D.

What about the situation where a medical group drops an MA plan in June? Their patients don't have the opportunity to switch to another plan and keep their doctor. How is that crap protecting the public?

I can ALMOST deal with AEP, but why not have at least one SEP for everyone during the year? People who qualify for a LIS have no enrollment periods - why are they special? Because they're low income?

Rick

I disagree with you and agree with you. First, the disagree. Year round enrollment wasn't flawless before part d, the billing issues were horrific and there was too much churning from month to month. Part of that problem was CMS couldn't stay up to date with who had what insurance and so they would pay claims that MA plans should be paying and vice-a-versa, then it would easily take 3-6 months to clear that up which created more of a hassle for everyone. Patients hated it because they had to deal with repetitive and confusing billing, dr offices hated it because they had to chase their money all over the place, and CMS couldn't (and still can't) keep anything straight in a timely fashion.

Now for the agreeing time. I think it's total bullshit that someone's PCP can drop from a plan and they have to change PCP's. I also think it's total bullshit that folks can get enrolled in a plan they don't understand, go to use the benefits, and then end up much worse off than they were initially. It's a flawed system in it's entirety. With respect to the election period business, I can see the value in them having one "oh ****" change each year plus AEP. So every year when the plans change they pick one, then if they realize they made a horrible decision they get to change. The whole thing should be a non-issue though, skip the next paragraph to find out why.

My biggest complaint about the whole Medicare Advantage program is that it's not developed, managed, or adjusted by industry experts. It's like taking your car down to pizza hut and asking the guy that answers the phone to remove a tumor on your spine after showing him the x-ray in a dimly lit lobby then handing him a dirty butter knife someone was using to cut their pizza. Congress does NOT understand how healthcare works.

The government should be self-funding the actual cost of the healthcare and only paying carriers to admin it. A little known fact is that Aetna paid the first Medicare claim and that was 20 years before Medicare Advantage as we now refer to it was born. To look at this from a strictly "what would help the most people" perspective we need to cut out the garbage where the benefits are drastically different form one area to the next. Original Medicare needs to be fixed and private carriers should be paid a small monthly fee to admin it and perhaps bonused off of reduction in cost of services/increasing quality of care or something to that effect. I know what you're thinking, "Man, this guy is talking crazy", but here is the fundamental problem with MA. It's guaranteed issue insurance, that makes NO F***ING SENSE. None at all. If you buy care insurance, they check your driving history, if you buy life insurance they want your age and health history, if you buy a house they want to know the condition of the property and the claims history. Is this because the insurance industry couldn't do it GI? Not at all, it's just that the premiums would be out of control. Medicare Advantage is guaranteed issue health insurance for the most expensive segment of our population to insure. Guaranteed issue means high premiums, plain and simple. With life insurance, take a look at Presidential Life, they'll write almost ANYONE within the age brackets, but the premiums are off the hook and the benefits are garbage compared to anything underwritten. Group health is guaranteed issue and so the premiums on fully insured business can be pretty sizable, so what do most large group employers do? They self insure. They pay a health insurance company to to the administration (network management, pay claims, manage operating funds, etc) and they assume all or the majority of the risk themselves. Most if not all state governments do it that way because it just makes sense, so why isn't congress doing that with over 10 million seniors on Medicare Advantage plans? It's a flawed system in it's entirety, but a step towards resolving the discrepancy would be for them to make the plans the same nationally, the same way original Medicare works, and let the government simply self-insure the risk. It's ludicrous that they aren't doing that already. Ok, ok, fair enough, they actually ARE doing that with original Medicare, they have part b administrators that manage the funds and cut the checks, but that's how the whole damn problem could be solved. It'd fix the issue with the MLR too and help make it so companies can afford to stay in business and it doesn't turn into the complete clusterf*** that Mass is right now.

Not that I have an opinion on any of this.
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Lock in protects one entity, the insurance company. It is not good for anyone else.

Except for it being one of very few ways the insurance companies in this business get to limit their exposure. Let them underwrite MA programs and it's a level playing field, let them enroll 365/366 days each year, no problem. Life insurance is underwritten which is why year round enrollments are a non-issue. If someone gets diagnosed with a terminal illness and want to pay a carrier $300 to pay a $500k claim, the underwriters will kill that app and it keeps the rates down for everyone. That is how insurance works.