Future of PFFS if funding is reducedq

GreenSky · 10-12-2007, 08:42 PM

If CMS reduces the funding to PFFS to put the plans at no more than 100% of Medicare (a reduction from the 119%), what happens to them?

My guess is they go away and more PPO plans show up where the insurance company can pay the doctor/hospital less.

Perhaps this is the way we're going to solve the deeming issue.

Rick

*midwestbroker* · 10-13-2007, 12:04 AM

That would be my guess as well.

Humana is working on expanding on regional PPO plans.

Winter · 10-13-2007, 09:39 AM

Originally Posted by GreenSky

If CMS reduces the funding to PFFS to put the plans at no more than 100% of Medicare (a reduction from the 119%), what happens to them?

My guess is they go away and more PPO plans show up where the insurance company can pay the doctor/hospital less.

Perhaps this is the way we're going to solve the deeming issue.

Rick

I am new to MA's but I am going to take a wild and crazy guess that AARP offers only HMO and PPO plans. So, on the surface it looks like AARP is talking out of both sides of its mouth by offering AARP branded MA's while also lining up with the AMA to allegedly try to preserve physician reimbursements by robbing funding for MA's. However, if the funding cuts would only hurt the PFFS plans then the HMO or PPO plans (e.g. AARP) would get more of that business. If AARP is offering PFFS plans then that theory falls apart. I don't know. Just an observation.

Follow the money.

Winter

retread · 10-13-2007, 10:53 AM

As the old saying goes, "statistics never lie, but liars use statistics". I am cautious with the repeated statements about PFFS plans costing 119% of Medicare. I have been told that figure came from the 2006 data, and that 2007 data is showing 112%, and that is the expected trend.

Theory is that, given a couple more years for PFFS plans to mature, they will equal or better Original Medicare. That seems reasonable to me, but how could I know better? Where is this data reported? I have a problem trusting reporters or other self-styled sages (including insurance agents) repeating statistics they don't really know about, or where they came from, or who might be taking the numbers out of context to forge their own private agenda.

To add to the original post: I was in a FMO seminar recently, where it was said that, if MA funding was cut off completely, we would still have funding for it until 2010. That we need to concentrate on is what we have NOW and not what we MAY NOT have at some future date. This is a reasonable approach. Even if the truth of the present funding is different than what he reported, this logic still stands.

I would appreciate it, if someone would put a link somewhere on this forum as to where this data is officially reported.

*midwestbroker* · 10-13-2007, 11:09 AM

From what I understood, funding was supposed to do a gradual decrease over the next handful of years to eventually equal 100% of Medicare costs.

I do not have an article or info to post, but I do remember reading that.

retread · 10-13-2007, 11:13 AM

Thanks, Mike.... I feel your pain! I have a good memory, too... it is just short!