Insurance Agent Forum

[MedSuppPro]

"As you may know, Congress may prevent a scheduled July 1 Medicare payment reduction to physicians. This could cost about $8.4 billion over five years. A number of proposals to pay for this so-called "physician payment fix" include:

• Cuts to indirect medical education (IME) from the MA rates;
• Reductions to MA funding for PFFS;
• Phase-out PFFS in all but rural counties.

Each of these options would have a serious impact on Medicare Advantage members and plans. Timing is crucial. Please contact your U.S. Senators and Representative in Congress to voice your opposition to these Medicare Advantage cuts.

A toll free number is provided below to reach your Senators and Representative in Washington, D.C.
Message:

• Medicare Advantage programs provide important coverage options to seniors in your state who otherwise would have limited alternatives.
• Medicare Advantage coverage saves the average senior over $1,000 per year in out-of-pocket medical costs. Seniors in poor health save thousands more.
• MA plans would be unable to contract with many large urban hospitals without the IME payments in their rates. This could lead to access to care issues for members.
• The PFFS product should be retained as an option."

source: 04-30-08 E-mail copy from a major unnamed MA carrier

I better order some more MedSupp apps!

[floridabroker]

These last two months we have had more people drop supplements than ever before.

Many seniors just can't afford them anymore.

But of course most people could care less. As long as they make their cash. Sad!

We had 15 documented medicare fraud issues last year. this year we were handed over 50.

Funny thing is most (95%) of these came from Doctors that "only accepted medicare and med sups". Well I guess so, nice and easy for them!

In all of our counties and almost all of our products with the big exclusion being secure horizons, the MA companies pay 100% of medicare allowable.

So it sure doesn't make sense unless they have alterior motives for not accepting an MA plan.

A major doctor group in the miami area refused to join an MA plan this past summer. Two months ago they came to the MA asking to join. Shocked they asked why????

They said medicare started reimbursing REALLY slowly (6 weeks) and they just couldn't handle it anymore. Considering this MA was offering 105% and was paying in 3 weeks. They finally had to bite the bullet.

We sell supps to by the way! Just don't find much use for them here.

[Winter]

Originally Posted by Frank Stastny

I believe that we are going to see more and more doctors opting out of the PFFS plans, especially if that doctors practice is not in a large metro area. PFFS plans suck in rural America.

If you have AARP and all the medical lobbyists out there arguing that schedule medicare reimbursement rates to physicians should not be implemented and that it will have the effect of reducing the number of physicians participating in medicare, thus limiting choice. When asked where the money would come from, AARP and AMA et al argue that it should come from the excessive reimibursement rates (to carriers) for Pffs plans.

That's a longwinded way of saying that doctors have an incentive to help kill PFFS plans by not participating in them. Their cash is going to carriers, in a roundabout way, or so it is argued.

Winter

[Winter]

excuse, should read: scheduled cuts to medicare reimbursement rates..

Originally Posted by Winter

If you have AARP and all the medical lobbyists out there arguing that schedule medicare reimbursement rates to physicians should not be implemented and that it will have the effect of reducing the number of physicians participating in medicare, thus limiting choice. When asked where the money would come from, AARP and AMA et al argue that it should come from the excessive reimibursement rates (to carriers) for Pffs plans.

That's a longwinded way of saying that doctors have an incentive to help kill PFFS plans by not participating in them. Their cash is going to carriers, in a roundabout way, or so it is argued.

Winter

[floridabroker]

winter.

Great points!!

[samantha129]

I think that what will kill PFFS is CMS giving the physicians to many outs and the insured being nervous about the outs.

Such as, you call the Doctors office and they say they accept PFFS and then you then you have to call before your next visit and the Doctors office now says they will not accept it.

Then there's the old you and your spouse are on the same PFFS plan and have been seeing the same Doctor for years and you call and they'll accept you but they won't accept your spouse even though your on the same PFFS plan.

Granted, I've not had this happen to any of my clients and I doubt a physician would do this but just the fact that I have to explain this causes them to be skeptical.

CMS should have come down and said, if you accept medicare then your required to accept all PFFS plans.

I was told that the sticking point is that it's the accepting of the terms and conditions of the plan. Which can vary from one company to another.

Here in Ohio we don't have to worry about the 15% and if you travel to a State that has this, your responsible for this when your on a PFFS plan.

Also, about 6-9 months ago I read where Congress was looking at MA plans and realized it was costing them 15% more for an individual on a MA plan vs Medicare only. More than likely, I think Congress did not take into account that they pay an MA plan with Part D built in another $75+ a month for this benefit and this could account for the 15% difference.

[midwestbroker]

When the government starts talking about saving money, it would be like Hitler saying "Why can't we all get along."

Fiscally responsible and government do not go together. This is the same government that has spent billions on poverty with no results, billions on the war on drugs with no results, billions on pork projects, etc.

AARP has enough influence on our senate / congress that what they say is going to usually fly. The first time the government wanted a lock in (back in 2000/2001ish) AARP said no way, and there was no lock in. This last time in 2006 AARP did not oppose it so it happened. Then AARP said MA/MAPD plans are ok but they should be funded at 100% of the normal costs of Medicare and not 115% or higher. That has yet to happen, but they have not pushed the issue.

[GreenSky]

Originally Posted by midwestbroker

When the government starts talking about saving money, it would be like Hitler saying "Why can't we all get along."

Fiscally responsible and government do not go together. This is the same government that has spent billions on poverty with no results, billions on the war on drugs with no results, billions on pork projects, etc.

Spoken like a true libertarian!

Rick

[midwestbroker]

Thanks Rick!!!

[midwestbroker]

Funny thing happened today. I took my wife to her doctors office since she was sick (she has strep throat but is fine) and there was a sign on the back of the patient room's door that read:

We do not accept Medicare as your primary insurance. However, we do accept some Medicare replacements policies. Please see the front desk for more information.

I asked the nurse about it and she did not know. The desk was busy when we left and my wife was tired so I did not want to wait just to ask.

[Winter]

Originally Posted by midwestbroker

AARP has enough influence on our senate / congress that what they say is going to usually fly.

This is true but the problem is that there are two AARP's these days. One side of the shop is for-profit and hawking MAPD's. The other side is advocacy oriented and arguing that we need to cut reimbursements to MA's in order to fund physician reimbursements to preserve patient choice. Which one will get their way? Without doubt the advocacy side if the dems are elected.

Winter

[MedSuppPro]

The Medical Group Management Association (MGMA) conducted a survey of over 1,100 medical groups nationwide (almost 30,000 physicians).

• Nearly 24 percent of respondents indicated they had either begun limiting or not accepting new patients.

• With the anticipated 10.6% scheduled cut to go into effect July 2008, nearly half (46%) of the respondents said that failure to halt cuts would lead them to stop accepting and or limiting the number of Medicare patients their practice treats.

On April 25th a client of mine received a letter from her clinic. In it it warns: "We want to stay open to all of our patients, but if Medicare will not pay enough to cover office expenses it will be harder and harder for this practice to provide care to Medicare patients."

[The Rabbi]

Originally Posted by midwestbroker

We do not accept Medicare as your primary insurance. However, we do accept some Medicare replacements policies. Please see the front desk for more information.

I know that doctors can be dumb but this takes the cake.