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Because gov't likes to coddle the poor and bend over backwards to make sure that every social program is offered to them. screw the middle class folk that worked for a living.
Because gov't likes to coddle the poor and bend over backwards to make sure that every social program is offered to them. screw the middle class folk that worked for a living.
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- 11,996
Straight up and honest to God (or god, or the flying spaghetti monster), it's because they claim that group of individuals is usually less informed and needs more opportunity to make options. How's that for crazy? The liberal elite doesn't need continuous enrollment.
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It was everybody dropping the ball. Here is a scenario that is not uncommon to hear providers bitching about, because it happened a TON:
Let us assume Mrs. Jones has Original Medicare January-February, UHC March-May, BCBS for June and July, Original Medicare for August, then goes back to UHC for the rest of the year. (if anything I'm not being ridiculous enough.)
Mrs. Jones goes to provider she routinely visits. They assume she has the same insurance and she forgets to tell them so then we have them filing their claim for the March visit to Medicare. Medicare gets them a rejection for services rendered March services and the denial says she has an MA plan, but does not say which one. They say "Mrs Jones, who is your insurance?" She then says (pick a carrier) and it may or may not have been the right carrier for each date of service (assuming a visit each month-6 weeks). Who's on first, What's on second, I don't know's on Third.
Let's also take a step back at just the hard costs on this: Paper, kits, marketing materials, mailers, telemarketers (was legal then), verification calls, claims processing fee, hours on the phone with customer service (Mrs. Jones sometimes, provider others), Medicare's processing time, etc, hopefully you get the idea. We also have commissions and chargebacks and premium reimbursements to the carrier. Oh, I forgot, back to the denial on the services being rendered, it wasn't a claim denial, the provider had a chargeback, so Medicare says give us our money back (or takes it out of their next check, not sure which) and they're paying their $12/hr office staff to chase a slew of $40 claims across a pile of carriers and no one knows what Mrs. Jones has or when she had it because her ID cards are never accurate.
Then we have the agents, who I as a carrier rep/agent manager/whatever they felt like calling me, I just want to line up all my agents and shoot them with one bullet for the messes they're creating from churning the business and not solidifying the sale enough for it to withstand the next agent that comes along to raise hell. Now, is that always the agents fault? No, but it still left me with tons of providers that want to do far worse to them then simply line them up and shoot them. Meanwhile, and most importantly, the senior is losing the ability to receive quality care because all of the providers comp is being eaten up by chasing the claims and the providers are like WTF am I taking this for? Mrs. Jones, go get a supp OR they just limit themselves to taking one carrier so the rate race will calm down a little.
I could literally go on for 10 pages, but does that help paint the picture?
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- 8,707
Yes and thank you for that...but things change (heck they change a lot in the MA market), From having an OEP to having a disenrollment period, plans change etc.....Rick brought up a good point about LIS having a year round SEP are these same issues present, where they present in the past and have smoothed out etc.
I think we have all had a client that will buy or change plan just based on someone new coming in the door. I'm just asking is there a better way than what we have now?
I think we have all had a client that will buy or change plan just based on someone new coming in the door. I'm just asking is there a better way than what we have now?
- 11,996
There are a few problems. Part of the problem is that insurance works by spreading risk, which is why we're all (at least the smarter ones) fuming about the whole GI mandate. Sure, folks that are ill should have a home to get coverage, but that is coming at the expense of everyone else and significantly so. To take it a step further, insurance works by spreading a similar risk over a large pool.
Here is a scenario for you:
Carrier A (real carrier, not real name) covers chemo drugs at 100% with a $15/visit specialist co pay. That is a HELL of a deal. In theory, anytime anyone needed those services they should just hop on that plan, I mean why not, they'd save a ton of money. Here is the problem, if even 10 people switched for that reason it would wipe out the plans viability. Might not even take that many, might only take 2 per county (it's a semi-rural area). Same situation, carrier B is who they had, every time anyone gets sick they leave carrier B and go to Carrier A, so despite the fact carrier A is offering better benefits, folks aren't killing carrier B's utilization so carrier B is making so much money they are hitting their 5% profit and having to give some of it back. What happens when they go to refile? Carrier A says "we lost our shirts, benefits now suck and with any luck we'll lose some high utilization members" and then Carrier B takes a bath on the claims for the next year. That ebb and flow is playing high stakes ***insanity***. If someone dies and they had a life insurance policy, the family will wish they had bought more coverage, but they can't just go add it after the fact.
Is there a better way? Absolutely, and I was discussing it here: Medigaps Going Up. What Happens to MA Premium? .
Here is the relevant quote (quoting myself of course, how vain):
"One interesting thing I would add is that MA carriers can't legally make more than 5% off of their plans and rarely is that even an issue. What really should be happening, and the drum I've been beating for a little while, is that the plans should be administering a standardized Medicare benefit and earn contracts by demonstrating their ability to reduce fraud, waste, and abuse as well as provide quality care. The real problem with the way MA is sucking off the american milk bag has less to do with the 15% more number and infinitely more to do with the fact that there are folks that rarely go to the doc, they pick up an MA plan and then the government is paying a minimum of around $800/month for a member they were paying quite possibly nothing for. Employers with as few as 500 employees are paying third party administrators to admin major medical and self insuring because they save money, what the hell do we think could be saved if the government did that with 43 million members. It's nuckin futs!"
- 8,707
Once again thank you. Question isn't your example a little simplistic and only pushing off that switch until November. Once the client needs those Chemo treatments they switch to the best plan effective Jan 1 and each year switch to the best plan for their needs...
I would say allowing the plans to underwrite would help but that won't happen because you don't underwrite people on original Medicare and a MA is only choosing Medicare through Part C opposed to A&B. And even if underwriting was allowed you would have to do something about how the carriers change the plans so drastically each year.
If I understand your solution "standardized Medicare Benefit" for a per member fee would probably work save the government and by that I mean we the taxpayers money...What would you say change the whole way Medicare is set up or do away with Part C or A&B and everyone has the exact same benefits and the carriers use their policies to detect fraud and abuse and cut that back?
- 11,996
The fact that you're even thinking that way proves that you're seeing the problem.
We can't kill a&b without uprooting everything and that would be unacceptable. a&b along with med supps help a lot of folks. Any legitimate solution would require NOT disrupting things drastically and that would be pandemonium.
Part C is a fine model, it allows for carriers to manage relationships with providers, curb costs, give seniors options, and a slew of other things. Hell, if we wanted to make it interesting we could give them an extra pmpm to give away the vision, dental, whatever. By giving them the standardized MA plans to admin only on we'd be comparing apples to apples. Hell, it could mirror the A&B benefit, it just needs to be admin'd by carriers that are actually driving cost down.
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By turning Medicare into a voucher system the problem may not be solved, but certainly mitigated.
If everyone had $750 a month to spend on insurance they are back in control. Just like non-Medicare insurance, people will have the choice to buy only what they need. Want a $5K deductible, great, you have $150 left over for dental, etc. Need 100% hospital, you'll have to kick in $150 a month.
This is a bit simplified but it gets the government out of the insurance business and back into what they do best - restricting our Constitutional rights.
Rick
If everyone had $750 a month to spend on insurance they are back in control. Just like non-Medicare insurance, people will have the choice to buy only what they need. Want a $5K deductible, great, you have $150 left over for dental, etc. Need 100% hospital, you'll have to kick in $150 a month.
This is a bit simplified but it gets the government out of the insurance business and back into what they do best - restricting our Constitutional rights.
Rick
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I'm thinking about this because the way CMS runs Part C&D is crazy from a consumer and agent standpoint. I can understand the carrier issues that you have brought up.
If you leave A&B and Supps alone but then made MA plans standardized and mirroring A&B how would that work?
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The other area is how restrictive marketing rules are for C&D plans...Couldn't we have more reasonable marketing rules if say we submitted to maybe an additional CMS certifiaction and background check. I know there have been bad agents and agencies out there but the thing that always struck me as strange about some of these marketing rules is that seniors don't know all the marketing rules so still get bamboozled by bad agents who ignore marketing rules why the good agents are hampered the restrictive marketing rules and CMS mandated compensation... Think about how many good agents have turned their backs on MA plans and will not help those consumers that would benefit from Part C plans.
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- 11,996
This isn't my ideal solution, but an a more apples to apples option that provides clearly identifiable cost savings would be:
Beneficiaries would have two options, a&b through Uncle Sam, or the same through private carriers. One problem would be that they would need an incentive to switch other than preserving the Medicare fund and in my total and complete solution (which I have yet to write and would most likely be somewhere in the 50 page range) that issue is addressed, but for the sake of just discussing the numbers, if everything was turned over to MA carriers as an apples to apples comparison on the admin only side of things we'd see that the private sector can provide a higher quality of care (customer service) at a lower cost. It would also be interesting to see if the utilization was drastically different enough if carriers would sell a supp type product for the part c "a&b" option and the rates would be lower based on the fact that they have to fill the gaps of anything Original Medicare (OM) doesn't cover. If the part c plan denied a claim they wouldn't have to pay the balance and if that resulted in them paying out less fraudulent, wasteful, and abusive claims then it would stand to reason the utilization would go down, so maybe a plan f with OM would be $125/month and a "plan f" for a part c "a&b" would be $100/month. Maybe that would be an incentive for folks to switch.
I think the real take away from all of this is that congress and CMS and HHS have no idea what they're doing. There are plenty of innovative solutions for the problems that could make everyone happier than where they are now without eliminating or underfunding existing programs.
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