Who Pays for Medicare Ads?

[StephanieCJ]

More and more, healthy clients are choosing MAPD and sicker clients are choosing Supp. This is the case even when presented with the fact that they will not be able to pass underwriting in the future if their health does take a turn. Of course, there are always exceptions to this (such as healthy people who want the freedom to see any doctor they choose). I don't really see a problem with some of the extras (like limited rides to doctors visits), but there is clearly a problem when the health plan offers grocery cards or will take them to the pharmacy at Walmart where they pick up one med that could be mail ordered and do their grocery shopping while there. At some point, CMS is going to have to reel it in and people are going to be mad when plans cut benefits.

 

[somarco]

healthy clients are choosing MAPD and sicker clients are choosing Supp.

They must think they will always be healthy . . .

https://khn.org/news/as-seniors-get-sicker-theyre-more-likely-to-drop-medicare-advantage-plans/

 

[somarco]

CMS is going to have to reel it in and people are going to be mad when plans cut benefits.

I don't see CMS being the bad guy and cutting benefits.

More likely the carriers will pull in the reigns

 

[StephanieCJ]

I don't see CMS being the bad guy and cutting benefits.

More likely the carriers will pull in the reigns

CMS will have to either cut the funding or the government will have to print more money (which they seem to be okay with these days considering the number of people who erroneously believe that modern monetary theory is a great idea in practice). If they cut funding, carriers won't have a choice but to reduce benefits. CMS is also handing out higher star ratings like crazy this year, but I don't see much changing from a quality standpoint from when I first started doing MAPD about 6 years ago. Higher star ratings=higher funding per enrollee.

 

[Up In Smoke]

CMS will have to either cut the funding or the government will have to print more money (which they seem to be okay with these days considering the number of people who erroneously believe that modern monetary theory is a great idea in practice). If they cut funding, carriers won't have a choice but to reduce benefits. CMS is also handing out higher star ratings like crazy this year, but I don't see much changing from a quality standpoint from when I first started doing MAPD about 6 years ago. Higher star ratings=higher funding per enrollee.

CMS is handing 5-star plan ratings like candies, don't know if that shows real improvements or just the "inflation" of plan ratings to release more fundings to carriers.

 

[StephanieCJ]

CMS is handing 5-star plan ratings like candies, don't know if that shows real improvements or just the "inflation" of plan ratings to release more fundings to carriers.

I think its just inflated ratings, because I'm not noticing any real difference on the plans except maybe office staff doing a better job in some instances with prior authorizations and billing.

 

[Up In Smoke]

I think its just inflated ratings, because I'm not noticing any real difference on the plans except maybe office staff doing a better job in some instances with prior authorizations and billing.

That would fit nicely into the economic inflation...they are printing money anyway and the carriers want the inflated fundings to not lose revenue.

 

[Real_AMG]

I think its just inflated ratings, because I'm not noticing any real difference on the plans except maybe office staff doing a better job in some instances with prior authorizations and billing.

Plan ratings are based off of a variety of factors, most notably including member reported satisfaction. The plans with 5 star ratings this year almost directly correlate in most cases with the market share of the carriers in that region. The higher the market share, the greater likelihood that the plan received 5 stars.

Also, I hate to be the one to tell you this, but funding for plans is correlative with star ratings. The higher the rating, the more money from CMS. The influx of 5 star plans means funding for MAPD is going up, not down.

But hey, I wouldn’t lose hope yet. It’s looking like they’ll ban Advantage and make OM + Supps mandatory any day now.

 

[DonP]

Ban? Lol. Mapd an unstoppable freight train . One reason hospitals hate mapd is many people stiff them on copays . They get paid much better with OM.I’m getting so many referrals to help people my heads spinning . I bet 20% of my business is people with no plans .

 

[Bill_Kiray]

Just a couple of things on this:

• There is no financial difference to a plan at 4.5 stars to one that is at 5 stars. I used to think 5 stars got more than 4.5, but I've had multiple carriers tell me that isn't the case.
• Market share has nothing to do with getting a 5 star rating. I can understand why it looks that way this year with the influx of new 5 star plans, but typically more members hurts a plans ability to achieve a 5 star rating.
• You wouldn't see any immediate difference in a plans benefits for 2022 because they earned a 5 star rating for 2022. The $$$ that a carrier receives is based upon their rating from the previous year, which is based upon their performance the year before that. Performance in 2020, Evaluated in 2021, Rating for 2022, Revenue in 2023.