Medicare Advantage or Not?

[lmilgram]

This is my first post to the forums and I apologize if it is in the wrong section.

I have a large self-insured client (2,000 active members and 500 medicare eligible retirees) who currently offers and EPO and PPO for the active group and Medicare Advantage for the 65+ retirees. The client pays 100% of the MA premium and most of the active premium.

The client has suggested that with steadily increasing MA rates, perhaps it would be less expensive overall to include the retired 65+ population into the EPO and PPO plans with the rest of the employees. The thought is that since regular Medicare will pay first for the 65+ retirees the costs picked up by the client will be minimal and there will be a larger population to share the premium equivalent thus reducing rates for everyone.

I am interested anyone's experience with this type of arrangement, as well as resources so I can put together a cost benefit analysis for the client. I am fairly new as a broker, but have a background in healthcare data analysis.

Thank you in advance for your input.

LRJ

 

[Rollem]

Sounds like a great start. Also, sounds like you are on the right track although I can't add much value here. I will be interested to see responses and how this turns out for you. Good luck.

 

[somarco]

What is the cost (per employee) for the group MA plan?

I suspect you are on the right track, dropping the MA and letting Medicare pay first, but it would help to know the MA cost.

 

[HealthMarkets1]

There are definately some good options, the guys are correct, what state
and how much for the MA's. Good luck....Its a good situation for you.
Best of luck!

 

[Ann H]

I have a large self-insured client (2,000 active members and 500 medicare eligible retirees)...

The client has suggested that with steadily increasing MA rates, perhaps it would be less expensive overall to include the retired 65+ population into the EPO and PPO plans with the rest of the employees.

The thought is that since regular Medicare will pay first for the 65+ retirees the costs picked up by the client will be minimal and there will be a larger population to share the premium equivalent thus reducing rates for everyone.

Isn't Medicare primary only for groups with less than 20 FTE's, and the group plan is primary for larger groups?

 

[WCMason]

Isn't Medicare primary only for groups with less than 20 FTE's, and the group plan is primary for larger groups?

That is true if the one receiving benefits is actively employed. For a retiree eligible for Medicare the employer benefits are secondary without regard to number of FTE.

 

[Ann H]

That is true if the one receiving benefits is actively employed. For a retiree eligible for Medicare the employer benefits are secondary without regard to number of FTE.

Thank-you for the clarification.

 

[carithomas5141]

Very good idea to let the medicare pay first and helping people to get more benefits on low premiums but have to see have that all shaped up in reality because many people will be against this scheme.

 

[lmilgram]

Update: I spoke with the insurance carrier and they are working on obtaining the 65+ (Medicare Primary) pmpm cost to complete the analysis. This particular plan pays 100% of submitted fees after Medicare. (if the Dr. charges $100 and Medicare pays 80% of approved, the plan will pay the difference up to the original $100).

Based on rough numbers, the premium per contract will decrease across the entire plan, however the total cost to the client will likely increase. The client is self-insured and the cost of the community rated Medicare Advantage premium is less than the anticipated claims (including Rx) for the 500 Medicare primary members.

-LRJ