Medi C & D Insurers Plummet

[policy doctor]

Actually....I have presented both sides of the argument. Med supps and MA's. I let the client choose, otherwise they will cancel.

My point in posting this HR bill is surprise that PFFS plans will be asked to build a provider network. I think that is a good change in the works. Since i had sev dr offices refuse MA plans my clients had to find other doctors who would. We need better stability in this system.

Yes..MA's are Plans. Med Supps are Insurance. Big difference.

 

[MedSuppPro]

HR.6331, The House Medicare Improvements for Patients and Providers Act... require Private Fee-For-Service plans to establish provider networks, rather than "deeming" doctors to be part of the plans...

Why not call these plans PPO or HMO? Managed care was the rational behind the MA program to begin with anyway.

Also, Bob (t.i.g.) has a point. "W" still needs to sign this and I've heard he will not.

http://www.bloomberg.com/apps/news?pid=20601124&sid=aBI26L6PHrRo&refer=home

 

[Guest]

MA plans are adjusted every year. This reflects the Medicare capitation fee, claims, number of members, etc. Some years premium will go down, others it will rise.

Humana has been all over the place. Their HMO in KC this year is $16, last year $19, year prior $8, year prior $20ish, year prior $30ish, etc.

Coventry has been $0 since 2005, prior to that is was about $19.

Both carriers (and I use them because they are the main carriers in KC) have picked up counties in the last few years.

So, for now, they are on the upswing. Will this always be the case? Who knows. We can only go year by year.

I can tell you there will be no new SNP plans next year as Medicare put a freeze on expanding them. Why? I do not know, but that is what I have been told.

so what happens to those folks with SNP qualifying health issues next year ? this makes me very curious and concerned.

 

[MedSuppPro]

The Senate, on a 69-30 vote, appears to have passed the measure by a wide enough margin to withstand a White House veto threat. Doctors avoid a pay cut and MA plans are hit.

What will the AEP look like? This could get ugly!

 

[GreenSky]

The Senate, on a 69-30 vote, appears to have passed the measure by a wide enough margin to withstand a White House veto threat. Doctors avoid a pay cut and MA plans are hit.

What will the AEP look like? This could get ugly!

I think the MA plan funding is locked in for 2009. But 2010 will be very interesting.

HMO and PPO plans should be okay, but we can probably kiss the PFFS plans goodbye.

Rick

 

[theinuranceguy]

I think the MA plan funding is locked in for 2009. But 2010 will be very interesting.

HMO and PPO plans should be okay, but we can probably kiss the PFFS plans goodbye.

Rick

PFFS should of been gone a long time ago...

We need a PFFS plan that works like a supplement...

A Supp, as in there is no network, and all Dr.s accept it...

 

[MedSuppPro]

HMO and PPO plans should be okay, but we can probably kiss the PFFS plans goodbye.
Rick

Will CMS grant MedSupp Open Enrollment for the PFFS plan members? They should.

What if their doctor or hospital is not a member of the 2009 HMO or PPO?

What if they have a PFFS plan with zero hospital copay's (i.e. Coventry) and then are offered an HMO or PPO plan with a $1000. co-pay? This will happen...

Seems material enough for CMS to do what they did back in 2001. The then secretary Tommy Thompson said give em an Open Enrollment MedSupp and so it was done...

 

[GreenSky]

PFFS should of been gone a long time ago...

We need a PFFS plan that works like a supplement...

A Supp, as in there is no network, and all Dr.s accept it...

Great idea. In fact, maybe the Feds could standardize these plans and to make it easy to understand assign letters to each of those standardized plans like A, C, F, etc. There would have to be premiums paid which could vary from carrier to carrier.

If only we had something like that.....

Rick

 

[GreenSky]

Will CMS grant MedSupp Open Enrollment for the PFFS plan members? They should.

What if their doctor or hospital is not a member of the 2009 HMO or PPO?

What if they have a PFFS plan with zero hospital copay's (i.e. Coventry) and then are offered an HMO or PPO plan with a $1000. co-pay? This will happen...

Seems material enough for CMS to do what they did back in 2001. The then secretary Tommy Thompson said give em an Open Enrollment MedSupp and so it was done...

If someone has an MA plan that ceases to exist, CMS doesn't have to grant any open enrollment. Everyone has this once a year. However, in this case, they can go into a Med Supp on a guaranteed basis.

If the MA plan increases the member's cost for ANYTHING (could be $5 a day for hospital), they can go into a Med Supp on a guaranteed basis. (I know this works for California, not sure about other states).

The issue is one of cost, not of access. Obviously the best access is a Med Supp but many of the people on PFFS can't afford a high premium. Don't know what they'll do but I'm pretty certain I'll write a TON of supplements.

I've been worried about my PFFS clients for years because of this deeming crap. It will be a relief when the plans as we know them go away.

Rick

 

[jdeasy]

If someone has an MA plan that ceases to exist, CMS doesn't have to grant any open enrollment. Everyone has this once a year. However, in this case, they can go into a Med Supp on a guaranteed basis.

If the MA plan increases the member's cost for ANYTHING (could be $5 a day for hospital), they can go into a Med Supp on a guaranteed basis. (I know this works for California, not sure about other states).

The issue is one of cost, not of access. Obviously the best access is a Med Supp but many of the people on PFFS can't afford a high premium. Don't know what they'll do but I'm pretty certain I'll write a TON of supplements.

I've been worried about my PFFS clients for years because of this deeming crap. It will be a relief when the plans as we know them go away.

Rick

The ones that will suffer from this are the PFFS members. I do a ton of PFFS and they almost all to people that had no med sup because they couldn't afford one. I replace very few med sups because I tell folks that med sup is the only way to go if they can find a way to pay for it.

What about the SNP's and the medicaid duals? They can't afford a med sup. The PFFS have been a life saver for millions of rural seniors.

This legislation is indeed a death knell for the PFFS. These insurance companies that pushed for this thinking they were going to get a huge number of new med sup members are going to be very dissappointed.