The Future of Medicare Advantage?

[DS4]

The Medicare Part A deductible increased from $1068 to $1100, and, the Part B deductible from $135 to $155 last Jan 1st. I hope none of my supplemental carriers go bankrupt.

MA's(Ins Co's) rely on capitation payments from the Federal Gov't. The back Jesus hates Ins Co's. Therefore, MA's have the shelf life of a carton of milk in your frig.

 

[jsanchez001]

DS4,
As far as I know "the black Jesus" who hates insurance companies, is not doing anything that any sane person would not do. If you remember in 2006 when the MA were revamped, they were supposed to bring "competition" to Medicare, the only problem is that the Insurance companies did not compete on the same level with Medicare (they got between 14-20% more per patient). Now the "black Jesus" is leveling the playing field by paying these companies the exact amount that it will cost Medicare to take care of the recipient. It seems that insurance companies only espouse competition when it is to their advantage!!

 

[jwb0007]

The Medicare Part A deductible increased from $1068 to $1100, and, the Part B deductible from $135 to $155 last Jan 1st. I hope none of my supplemental carriers go bankrupt.

MA's(Ins Co's) rely on capitation payments from the Federal Gov't. The back Jesus hates Ins Co's. Therefore, MA's have the shelf life of a carton of milk in your frig.

Please explain "unpaid Medicare-covered charges" ???

Opinion is, of course, opinion. However, the fact is that if payments under MEDICARE ITSELF (to all Medicare reimbursement schemes) are going to be reduced, then that includes the portion of covered procedures paid to medicare supplement policies as well. Doesn't it?

It may be that an agent has a preference for one type of coverage over another, but I find that facts and rational analysis are more likely to lead to correct conclusions and courses of action.

Jim Boyd

 

[jdeasy]

Opinion is, of course, opinion. However, the fact is that if payments under MEDICARE ITSELF (to all Medicare reimbursement schemes) are going to be reduced, then that includes the portion of covered procedures paid to medicare supplement policies as well. Doesn't it?

It may be that an agent has a preference for one type of coverage over another, but I find that facts and rational analysis are more likely to lead to correct conclusions and courses of action.

Jim Boyd

No, it does not work like that. Supplements pay the difference of the medicare approved rate. If Medicare reduces the approved rate, then the supplement would pay less, not more.

 

[jwb0007]

One more time. The original discussion thread, and subsequent comments, voiced the opinion that MAPDs are ready for the boneyard. Perhaps.

However, the point I sought to make is that med supps are no less in danger, and subject to pricing decisions--by the issuers and the prospective purchasers.

If Medicare pays for less, yes, the med supp policy MAY be obligated to pay less, if that obligation is a fixed percentage of the Medicare payment.

However, Plans F & J (in particular) have been priced and marketed as paying the entire balance of unpaid Medicare-covered incurred expenses. If the policies pay less than the entire balance, that unpaid balance becomes an obligation of the policyholder. In other words, Medicare's lowered payments impact med supps just as negatively as MAPDs.

Medicare supplement policies are not immune to the level of Medicare payment/reimbursement, and they will suffer just as MAPDs will.

Enough said?

Jim Boyd

 

[jdeasy]

One more time. The original discussion thread, and subsequent comments, voiced the opinion that MAPDs are ready for the boneyard. Perhaps.

However, the point I sought to make is that med supps are no less in danger, and subject to pricing decisions--by the issuers and the prospective purchasers.

If Medicare pays for less, yes, the med supp policy MAY be obligated to pay less, if that obligation is a fixed percentage of the Medicare payment.

However, Plans F & J (in particular) have been priced and marketed as paying the entire balance of unpaid Medicare-covered incurred expenses. If the policies pay less than the entire balance, that unpaid balance becomes an obligation of the policyholder. In other words, Medicare's lowered payments impact med supps just as negatively as MAPDs.

Medicare supplement policies are not immune to the level of Medicare payment/reimbursement, and they will suffer just as MAPDs will.

Enough said?

Jim Boyd

It may be enough said, but, it's still not accurate. F and J only pay the balance of the "medicare approved" amount. If it's not medicare approved, they don't pay anything. They do pay the excess charges, but, that is also capped at 15% and if the medicare approved amount is reduced, then 15% over is also less money than they are paying now.

You, either, don't understand how medicare and medigap work together or you are just playing devil's advocate?

 

[DS4]

Medicare supplement policies are not immune to the level of Medicare payment/reimbursement, and they will suffer just as MAPDs will.

Please explain your logic??
MA's survive on capitation pymts from the gov't. Without capitation pymts, MA's vanish. Period.

Currently, 99% of providers participate in Medicare Part B as Par or Non Par providers. Lets say Medicare cuts all Medicare fees -5%.
This is actually good news to Medicare Supplemental carriers from a loss ratio standpoint.

 

[Russ]

However, Plans F & J (in particular) have been priced and marketed as paying the entire balance of unpaid Medicare-covered incurred expenses. If the policies pay less than the entire balance, that unpaid balance becomes an obligation of the policyholder. In other words, Medicare's lowered payments impact med supps just as negatively as MAPDs.

Those 2 policies can't pay less than the entire balance unless it's a charged not approved by Medicare. Supplements pay, IF Medicare pays...which it usually does.

There is no balance after Medicare and plans F or J get through paying.

 

[Frank Stastny]

Jim,

It may be easier for you to see that Med Supps are designed to pay the balance that is unpaid by Medicare by looking at the outline of coverage for the different Med Supp plans. I think all you have to do is look at the column titled "You Pay". You will see that with Plan F there are zeros, "0's", shown in every category. (Plan J will not be available after May 31.)

When compared to individual health insurance Med Supps clearly state what is paid and how much the policy holder will be obligated to pay. Whether Medicare decides to pay less or more is not significant. Plan F will pay the balance regardless. With the exception of Medicare Part B Deductible and Excess Charges Plan D will also pay 100% of approved charges not paid by Medicare.

Plan F is probably the easiest to explain to a prospect because regardless of the questions asked by the prospect all the agent has to do is say, "Plan F pays the balance", you pay nothing". It is one reason why Plan F is so popular for agents to sell and why so many seniors have a Plan F.

If you would like to discuss it further please give me a call.

 

[Newby]

Thinking outside the box there are a few things that COULD happen to MA plans.
1. If they need to compete head to head with Medicare it could change to where they mimick the benefits of A & B plus add benefits that are not in Medigap plans (dental, silver sneakers, etc.) and allow you to buy a Medicare Sup in addition since they are mimicking A & B. This would give people true choice that prefer private insurance to the government being their insurer.
2. They could become priced equal to Med Sups and see if they can make a more attractive product than A & B with a Med Sup plus part D.
With the current plans people are only paying around $14 for a pretty good plan. These are going to end.
But if the only alternative is a $125 Med Sup and a $35 Part D plan, they could bring out $150 MAPDs that COULD be more attractive than that and compete.