MA Plans

[stormtracker]

You're getting old. Just stick to your knitting and you will be okay. In a couple of years you will be able to hide your own Easter eggs. Something to look forward to.

I just found an Easter egg the other day-- it was still good. I can only surmise that it was from this year...

 

[The Hunter]

I'm not saying the sky is falling, what I've said is it will affect loss ratios which could easily result in a reduction of benefits. When plans are doing their benefit designs they specifically try to create plans that are unattractive to unhealthy people or those who may need to use their benefits for more than a few doctors visits and a couple of prescriptions.
Where are your LIS enrollment numbers? Without looking at the same numbers you're looking at, it's difficult to tell. One reason why the LIS members might not be changing their plans is because they have state subsidies and their out of pocket costs on healthcare could be funded 100% so it makes no difference to them personally which plan they're on. If you're talking about other LIS eligibles, it could be the result of them not being aware of their ability to change plans or them not having a drastic change in their healthcare needs.
The MA program, as it sits now, would have to go out of it's way to be run more inefficiently. What Medicare is really doing is buying GI individual health insurance for seniors who want it. Fully insured GI coverage is the most expensive way to finance the cost of healthcare and that's exactly what the government is doing.

If my theory is that companies that offer the least competitive benefits get rewarded by not having to pay big claims, there should be evidence of that now, right? A few quick questions:

What company has the most MA members in the country?
Are their benefits generally the most competitive?
How profitable is their book business?

The answer to the first question, hands down, is UHC followed by Humana.
The answer to the second, not really. Across all of the markets I've worked in, reviewed, or had agents in UHC rarely had a product that was competitive unless it was a SNP product. Even at that, the "chronic care" plans usually had weaker benefits than any of the other plans, even if they were competing against another health insurance giant like Aetna.
Question three, profitability. If the Medicare arm of UHC was it's own entity it would make the Fortune 500 on it's own. Even before the Medicare Modernization Act of 2003 UHC was doing well with it's MedicareComplete products in markets carriers wouldn't have dreamed of going into until the reimbursements were adjusted and lock-in was instituted.
http://www.kff.org/medicare/upload/2052-12.pdf
It would appear that UHC (along with many other carriers) has developed the strategy of offer a plan that has so many holes and gaps in coverage on it that if we ever get a member, it's guaranteed to be a moneymaker. With any extra money they'd be using to pay claims, they took a portion of that and used it for marketing. Whenever a member got upset because they realized the plan they enrolled in had lousy benefits, UHC was more than glad to let the member walk to another plan as soon as the member was able, and then avoid paying the majority of the big ticket claims. It's genius, it really is, but it's taking Medicare dollars and giving them to insurance companies who have little intention on paying claims, and then letting a company that offers more comprehensive benefits take a bath on a new member as a penalty for doing the right thing. Why should Medicare dollars to go private health insurers that don't offer competitive plans at the expense of health insurers that want to provide the coverage, albeit for a slimmer profit margin? Why don't we dump lock-in and then just have Medicare pay carriers a small admin fee each month and then when a claim comes through let the health plan use Medicare dollars to pay for the claim so that America isn't fully insuring the risk on over 10 million seniors. Odds are that type of reform would be good for the members and would result in significant savings over the current program.

Medicare Plans Solutions,

I was enjoying the debate between you and JD EASY.
Both of you made some valid points. But your discourse on
who offers the least competitive benefits is nonsense.
Yes UHC is the largest MA carrier. I cannot speak for New
York ,I don't live there.I can speak for Georgia and Florida
and the UHC Plans are not only competitive,but in many cases superior.Following your logic the companies with the worst and least competitive product will capture the largest market share. Are you serious?? You have made some assumptions that you cannot document.Your reasoning is flawed.

 

[Josh]

Medicare Plans Solutions,

I was enjoying the debate between you and JD EASY.
Both of you made some valid points. But your discourse on
who offers the least competitive benefits is nonsense.
Yes UHC is the largest MA carrier. I cannot speak for New
York ,I don't live there.I can speak for Georgia and Florida
and the UHC Plans are not only competitive,but in many cases superior.Following your logic the companies with the worst and least competitive product will capture the largest market share. Are you serious?? You have made some assumptions that you cannot document.Your reasoning is flawed.

Glad you've been enjoying the debate, it certainly has been interesting. UHC is too large of a company to track their entire portfolio against all of their competitors in every market, which is why I said of the markets I know and in the markets I've worked they tend to have the least competitive benefits. Yes, I'm completely serious. UHC has more membership than any other MA plan. Here are some plan comparisons.
Cayuga County, NY:
Aetna: $0 premium/$0 PCP/ $5 SPC/ $0 inpatient hospital.
Fidelis: $0 premium/$0 PCP/ $0 SPC/ $300 per stay inpatient hospital
UHC: $0 premium/ $10 PCP/ $25 SPC/ $150 per day inpatient hospital days 1-19.

Pinellas County, FL:
Quality Health Plans: $0 premium ($25 rebate)/$0 PCP/ $5 SPC/ $150 per day first 5 days on inpatient hospital.
Aetna: $0 premium/$25 PCP/ $35 SPC/ $200 per day first 10 days on inpatient hospital.
UHC: $0 premium/$10 PCP/ $25 SPC/ $325 per day first 11 days on inpatient hospital.

The real interesting part is when you take a look at benefits like the part b drug coverage, you can find some serious gaps in the coverage MA plans offer. Aetna will cover a part b drug (think chemotherapy) for a flat $45, UHC covers it at 20% of Medicare approved. A good friend of mine recently passed away as a result of colon cancer, when she was going through treatment 1 drug alone was over $10k, that was only 1 part of the cocktail she was getting every two weeks. Situations like that run members to their maximium-out-of-pocket real quick.

I'm sure there are some areas where UHC offers the most competitive product in the market, but that's not necessarily the trend nationally. I'm not terribly familiar with the Florida market at the moment, but Quality Health Plans has product in almost 30 counties (29) and according to my friends at wikipedia Florida only has 67 counties. Again, I'm not familiar with the market so I could be missing something, but in less than 15 minutes of research it looks like QHP, a small, local carrier, is doing circles around UHC in nearly half (43%) of the counties in the state.

I can speak for Georgia and Florida and the UHC Plans are not only competitive,but in many cases superior.

Between QHP and Aetna alone I think at least half the Medicare beneficiaries in Florida have better options available than UHC. With at least another half a dozen carriers in the state, that number is bound to be higher than 50%.

I'm going to take a shot in the dark and guess that the reason why you're talking about UHC having more competitive benefits in GA and FL is because you live and market in a rural area near the border. Plans don't usually go through the expense of filing a product and building a network if there isn't a large enough population of Medicare eligibles for them to reasonably expect a solid return on their investment. In those areas, the only plans that would usually come to town were PFFS plans no one has ever heard of before and UHC. In those areas UHC is more likely to have the most competitive product, but that hardly accounts for the majority of the MA market. It's also worth mentioning that UHC will usually file a Regional PPO which is by design a less competitive product. For more info on that take a look at this: http://hcfo.net/pdf/ppo.pdf.
From the text: "Regional PPOs would be unlikely to attract large and stable enrollments without very costly ongoing subsidies from the Medicare program."