Part C is for the birds.

[Cenla Agent]

In the past, Medicare+Choice plans had year round enrollment (prior to it being called Part C).

They (the carriers) were also allowed to make mid year improvements to their plans. So, if their benefits were sub-par for the area, they could make mid year improvements.

Medicare tried in the past (I think around year 2000) to do the lock in like they have now. AARP voiced their opinion (which was no) and they overcame it. I am surprised that they allowed it this time.

A SEP for doctors leaving the network would probably be the closest thing they will get for changing plans. That is probably one of the reasons PPO plans are becoming more and more popular.

Although I don't know of any concrete examples of it occurring, I do know that with PPO plans there are circumstances in which out of network providers can be considered in network by the plan. But the member has to contact the plan first, certain conditions have to be met i.e. no other specialists within a certain radius, etc.

 

[Cenla Agent]

CMS cancelled the LEOP period in July. That was the big rules change for 2007.

My guess is that in the next year or two we will have open enrollment for MA plans year 'round. Or at least allow an SEP if the doctor no longer accepts the plan.

CMS has made it too hard for a senior to receive benefits. This has to change. If we enroll a senior in an HMO (for example) and as of 5/1 the doctor drops out of the plan - or drops dead - what is the senior to do? He or she is locked into a program that might not provide the benefits needed.

Don't get me started on PFFS. A large medical group in one of the counties in which I work is thinking about dropping Pyramid due to claims problems. What if this happens in May? Hundreds of seniors will lose all access to their doctors. This group probably has 30-50% of the business in this area!

While I understand that insurance carriers like the lock-in provisions, how is this rule expanding the choices seniors have in their health care? Isn't that what Part C was supposed to do?

Rick

I could be wrong, but I thought it was primarily CMS that wanted lock-in, and not necessarily the carriers.

 

[midwestbroker]

From what I understand (and I have been wrong a time or two) Medicare wanted the lock in to help the administrative aspect of the plans.

If the whole country was now involved in MA, MAPD, and Part D plans (as opposed to just the major metros with their MA plans prior to part D), then tracking the changes and reimbursements to carriers is a lot easier since the changes are limited.