Standardizing MAPD plans?

[Yagents]

The Medicare Payment and Advisory Commission is considering standardizing the supplemental benefits Medicare Advantage insurers can offer, to make it easier for beneficiaries to compare plans.

At its Jan. 12 meeting, commission staff, which advises Congress on Medicare, put forth several options for standardizing Part A and B cost sharing and hearing, vision and dental benefits. The proposed standardizations would not apply to additional supplemental benefits, or employer-sponsored or special needs Medicare Advantage plans

MedPAC mulls standardizing Medicare Advantage supplemental benefits

Medicare Payment and Advisory Commission considers standardizing supplemental benefits for Medicare Advantage plans to simplify comparisons for beneficiaries.

www.beckerspayer.com

 

[Limozine]

The problem with this idea is that human beings aren't "standard." They come in all shapes and sizes, with an infinite variety of needs and desires. An individual without any teeth may not give a rat's ass about dental. Yet he/she will be forced to pay (via tax dollars, if nothing else) for a plan that covers dental benefits for everyone else. And that's just one example.

 

[somarco]

standardizing Part A and B cost sharing and hearing, vision and dental benefits.

Standardizing A & B seems reasonable . . . but the add-on is a different animal, especially since that is an MA creation to pad the loss ratio's.



The MA payment structure allows for several ways for plans to earn profits. MA plans are paid based on annual premium bids made against a market benchmark that is set administratively by the Centers for Medicare and Medicaid Services (CMS) under statutory authority and depends in part on the quality rating achieved by a plan. That bid serves to establish plan revenues. The difference between those revenues and incurred costs are plan profits. A portion of the difference between plan bids and the market benchmark is returned to the plan in the form of a “rebate” (or a form of shared savings). That rebate must be used to provide extra benefits to beneficiaries that can entail reduced cost sharing, lower premiums, or supplemental benefits like vision, hearing, and dental services. The projected premium for the supplemental benefit associated with the rebate is based on an actuarial estimate, and thus differences between the projected premium and actual costs are profits. The Medical Loss Ratio (MLR) requirements for MA plans require that the difference between revenues and medical costs cannot exceed 15% of total revenues. In addition, optional supplemental benefits (distinct from the mandatory supplemental benefits associated with rebates) can be offered by MA plans at a cost to beneficiaries. Roughly 38% of plans offer such benefits. A plan’s margin for these optional supplemental benefits must be less than 15% of premiums. The plan’s margin plus the administrative costs of the benefit must be less than 30% of the premium.

Profits, medical loss ratios, and the ownership structure of Medicare Advantage plans

In a new blog post, Richard G. Frank and Conrad Milhaupt examine sources of earnings and profits by Medicare Advantage (MA) plans.

www.brookings.edu

 

[Duaine]

Dems' trying to kill MAPD's?

Biden admin threatening your Medicare Advantage plan. Here's what they're not telling you.​

Biden administration is cutting Medicare Advantage benefits and threatening high-quality health care for seniors.​

Depending on what CMS does, they could further incentivize seniors to move away from Medicare Advantage plans and toward traditional Medicare fee-for-service.

[EXTERNAL LINK] - Biden admin threatening your Medicare Advantage plan. Here's what they're not telling you

 

[axeman462]

aint gonna make a difference. cuts are coming all around. paycuts to doctors who accept traditional medicare happened already, and now 30% of doctors aint taking new traditional medicare patients.

Seniors are gonna have to just deal with it. The country is broke.

 

[Limozine]

aint gonna make a difference. cuts are coming all around. paycuts to doctors who accept traditional medicare happened already, and now 30% of doctors aint taking new traditional medicare patients.

Seniors are gonna have to just deal with it. The country is broke.

Broke, you say? Apparently not broke enough to stop hundreds of thousands of new free health care recipients from crossing the southern border every month.

 

[somarco]

30% of doctors aint taking new traditional medicare patients.

Citation?

 

[sshafran]

Seniors are gonna have to just deal with it. The country is broke.

Yep - but they won't. Not sure my generation will either. Can always gets kicked.

 

[InsuranceGuy29]

God forbid people have options that are tailored around their INDIVIDUAL and SPECIFIC needs. People are not "standardized." This is just another not-so-thinly-veiled attack on the Medicare Advantage program. The entire point of Medicare Advantage is so that people can get different types of coverage that is well-suited to them, SPECIFICALLY. Someone has got to get these commies out of office. I genuinely cannot take another term of this bozo insanity.

 

[Bob L]

Well, word has it that Belize is a pretty good place to move if things don't change in January '25. God help us.