Say Goodbye to Medicare Advantage

[moonlightandmargaritas]

Health Blog : Health Insurance Stocks Dive on Medicare Advantage Cuts

 

[patch36]

All the insurers need to do to compensate for the cuts is to raise co-pays, MOOP, and possibly premiums. It is only the ones who use the services that cost them, so the reduction of 15% of the subsidy can easily be recovered by adjusting the numbers. Humana already set the stage by promoting the reduction and cap on agent compensation. Now all that needs done to survive the cuts is make fairly slight changes to the plans to penalize those who actually use the medical services they offer.

When you examine it with a fiscally responsible attitude, why should it cost more to the government to subsidize the MA's? Isn't it a conservative philosophy that private industry can do just about anything cheaper and more efficiently than the government?

Who came up with the 115% compensation figure to begin with and why? Are the insurance company lobbyists that good, the government that stupid? Perhaps I answered that question just by asking the question.

 

[Mac1958]

Who came up with the 115% compensation figure to begin with and why?

That's a great question. Part of the deal is that Medicare providers were, based on the original plan, supposed to have taken a 20% cut in their Medicare fees by now. They weren't thrilled with that (tough to blame them), and Congress hasn't made those cuts. Hence, higher overall payments than were originally planned.

From a July 2008 article, discussing one of the cuts that didn't happen: "By a veto-proof majority, Congress moved today to roll back a plan to cut Medicare payments to the nation's doctors. A previous law, if allowed to stand, would have reduced reimbursements by 11 percent, and doctors cried foul."

As easy as it is for some to point the finger at the insurance companies, the real story is a bit more complicated.

 

[wstet]

Good Bye MA AND Good Ridence. Managed care? You mean managed profit margin and bottom line don't you? Do you honestly trust an insurance company to "manage your care" I think they are managing whats best for their bottom line. And when did Medicare become about gym memberships and dental? And MOOP? Plan F MOOP in my state for most people is $1200 or less. 65 year old in OE is $75 a month. Age 70 $94 a month. Mrs customer, MA is great until you become seriously ill, then it becomes the most expenssive gym membership you ever bought.

 

[midwestbroker]

What some people fail to realize is that Medicare monitors the profits of all MA plans. If their medical spending falls under 82% they are required to up their benefits or Medicare will not approve the plan. Most carriers spend about 86% for medical costs. That leaves about 14% for all other expenses.

So, in essence what you are saying wstet is that yes it is a managed profit line, by both Medicare and the carrier. Medicare does not nor has it ever allowed carriers to run wild with high profit margins.

 

[Mac1958]

Good Bye MA AND Good Ridence. Managed care? You mean managed profit margin and bottom line don't you? Do you honestly trust an insurance company to "manage your care" I think they are managing whats best for their bottom line. And when did Medicare become about gym memberships and dental? And MOOP? Plan F MOOP in my state for most people is $1200 or less. 65 year old in OE is $75 a month. Age 70 $94 a month. Mrs customer, MA is great until you become seriously ill, then it becomes the most expenssive gym membership you ever bought.[/quote]
===

Well, I'll try to explain, although I strongly suspect I'm wasting my time.

"I think they are managing what's best for their bottom line."
Typical profit margins for Medicare Advantage companies is 3.5% to 5.0% for that product line, which is lower than many other insurance lines, so this argument is flawed from the outset. Fortunately, competition and innovation are doing what they always do - creating more and more value for the client.

"And when did Medicare become about gym memberships and dental?"
Both the government and private insurance companies have realized that preventive care is key to overall cost containment, and we will see more and preventive care as a primary component in medical coverage as time goes on. President Obama has promised this, and the insurance companies see the clear value of it as well.

Perhaps you've never spoken with an 85-year old woman who, after a few months in a Silver Sneakers class, can now lift her arms above her head for the first time in years, after thinking she was permanently crippled by her arthritis. People like her will need to visit her doctor less frequently, access her drug coverage less frequently, and will contribute to the cost containment so crucial to our health care system.

Further, the social and emotional aspects of programs like Silver Sneakers have already been proven to improve overall health of seniors, leading to reduced provider visits and further cost containment. Perhaps a visit to a class and a conversation with a former shut-in, a senior who was essentially just waiting to die before they found this class, would open your eyes a bit.

The health and cost containment benefits of fundamental dental coverage should be abundantly obvious, so I won't burn any more bandwidth on this.

"The most expensive gym membership you ever bought."
You may not know this, but there are many seniors who cannot afford $125 for a Medicare Supplement plus another $45 for a PDP. $170 a month or more is simply beyond their means. Medicare Advantage plans have allowed these people to have a plan that they can actually afford, $10 or $15 doctor co-pays, $0 preventive care, annual physicals, an enhanced drug plan, and many other benefits to which they had no access before they enrolled. Do MA plans provide better coverage than a Medicare Supplement? No, obviously. But they do provide coverage that is much better than Medicare alone, and that's about all some people can afford.

Medicare Advantage plans give seniors a choice, and access to coverage they did not have. Are they for everyone? No. Are they for most seniors? I don't know. But a simplistic, "insurance companies are evil" argument does no one any good either.

....

 

[Winter_123]

Well, I'll try to explain, although I strongly suspect I'm wasting my time.

"I think they are managing what's best for their bottom line."
Typical profit margins for Medicare Advantage companies is 3.5% to 5.0% for that product line, which is lower than many other insurance lines, so this argument is flawed from the outset. Fortunately, competition and innovation are doing what they always do - creating more and more value for the client.

"And when did Medicare become about gym memberships and dental?"
Both the government and private insurance companies have realized that preventive care is key to overall cost containment, and we will see more and preventive care as a primary component in medical coverage as time goes on. President Obama has promised this, and the insurance companies see the clear value of it as well.

Perhaps you've never spoken with an 85-year old woman who, after a few months in a Silver Sneakers class, can now lift her arms above her head for the first time in years, after thinking she was permanently crippled by her arthritis. People like her will need to visit her doctor less frequently, access her drug coverage less frequently, and will contribute to the cost containment so crucial to our health care system.

Further, the social and emotional aspects of programs like Silver Sneakers have already been proven to improve overall health of seniors, leading to reduced provider visits and further cost containment. Perhaps a visit to a class and a conversation with a former shut-in, a senior who was essentially just waiting to die before they found this class, would open your eyes a bit.

The health and cost containment benefits of fundamental dental coverage should be abundantly obvious, so I won't burn any more bandwidth on this.

"The most expensive gym membership you ever bought."
You may not know this, but there are many seniors who cannot afford $125 for a Medicare Supplement plus another $45 for a PDP. $170 a month or more is simply beyond their means. Medicare Advantage plans have allowed these people to have a plan that they can actually afford, $10 or $15 doctor co-pays, $0 preventive care, annual physicals, an enhanced drug plan, and many other benefits to which they had no access before they enrolled. Do MA plans provide better coverage than a Medicare Supplement? No, obviously. But they do provide coverage that is much better than Medicare alone, and that's about all some people can afford.

Medicare Advantage plans give seniors a choice, and access to coverage they did not have. Are they for everyone? No. Are they for most seniors? I don't know. But a simplistic, "insurance companies are evil" argument does no one any good either.

....

I think that some of the points you made have merit, particularly in regard to the preventive and/or non-medical health related programs. However, if those programs are considered to be effective or valued, one could still ask whether the best way to achieve them is to overpay medicare advantage carriers and then see what optional benefits/crumbs trickle down to the enrollees.

Give the 15% extra or whatever to directly to the medicare beneficiary and give them a wide range of options that they can choose to design their own health related program to reduce medicare charges. Maybe they will use the funds to write down the cost of a supplement which will lead to more physician rather than hospital level treatment. Maybe they will use it to pay for a home care worker to come by and prepare a meal once a week and break up the loneliness a little and give them a ride to the doctor. Maybe they will use it to buy more food. Maybe they will decide to enroll in the Silver Sneakers because they value it rather than that it is a crumb offered to them. Maybe they will get some new skiis. Don't know. I think there is room to experiment with the "overpaying" a little to see if it results in a larger containment of costs, except that I would be willing to see it tried with a more consumer-driven program rather than carriers-on-the-public-tit program.

And if it didnt work, I would eliminate it, and if it did, I would try some more things. I just wouldnt get stuck on stupid. Probably more could be done with the whole HSA and medicare arena. Don't know. Just saying I am still willing to try experimental things as was intended with medicare advantage- I just want someone other than insurance carriers or the federal government to be in the drivers seat.

 

[policy doctor]

This was interesting reading that I thought others might like. Not necessarily in the right thread, but I didn't want to start a new one.

Humana’s New National Care Center Takes Consumer-Focused Health Care To The Next Level

 

[Daytona_Guy]

The Obama Manifesto says that you must eliminate the current regime before you replace it. It also says that you must act in haste, with the only objective being instant implementation without recourse. Basically, the definition of rape. America voted for this, now, let's see if we are stupid enough to tolerate it.

In his own words...

 

[MedSuppPro]

Just like George Busch and his stupid Social Security idea, Obama has stepped on the third rail.

All the seniors hear is: "I'm going to cut your Medicare". And seniors are mad as hell over ObamaCare. When you screw at least 10 million seniors whom have MA plans -- your Achilles heal gets inflamed!